Analysis of the Dutch Preferentiebeleid

Abstract

Generally speaking, medicines can be classified into those that are patented, meaning that they are protected and can only be sold under a specific name by a certain company, and those that are off-patent, meaning that various companies may produce medication with the same ingredients and therapeutic effect. Medicines from the latter category are referred to as generics. More often than not, generics are cheaper then patented medicines. For this reason it is in a country’s best interest to try and increase the use of generics in their health care system. Additionally, countries always aim to lower prices of drugs and keep them low, which also goes for generics. For these reasons, various policies exist to regulate pricing and reimbursement of medicines, including generics. This analysis is focused on the Dutch policy in place for pricing and reimbursement of generics, which, in Dutch, is known as the preferentiebeleid. In a nutshell, insurance companies in the Netherlands can use the preferentiebeleid to determine which specific generics from a group of similar medicines are reimbursed. To do so, insurance companies appoint the cheapest generics as preferent, and community pharmacists are to dispense these preferent generics to patients. Important to note is that each insurance company creates their own list of preferent generics, meaning that they all implement the preferentiebeleid in a different way. This policy analysis describes how, after about 15 years of implementation of this policy, the preferentiebeleid was able to lower prices and increase the use of generics in the Netherlands. Unfortunately, it was also found that this policy had unintended, negative effects: increased drug shortages and frequent drug switches for patients. A stakeholder analysis showed that these unintended effects negatively affect stakeholders like pharmacists, as their workload is increased, and patients, as drug switches confuses, or even angers them. In addition, this analysis compared the preferentiebeleid to other policies for pricing and reimbursement that are in place in European countries to see whether the Dutch policy would be implementable in other countries or if the Dutch can learn from the successes of other policies. Literature demonstrated that systems similar to the Dutch policy are also able to lower prices of generics and increase their use, but that these other countries suffer less from negative effects like increased drug shortages or medicine switches. Suggested adjustments for the preferentiebeleid based on successes from other countries include making several generics preferent instead of just one per group of similar medicines, and generalizing the preferentiebeleid for all patients regardless of their insurance company. Informal contact with a community pharmacists confirmed that these suggestions are in line with the wishes of pharmacists. Overall, this policy analysis shows that the Dutch preferentiebeleid is successfully fulfilling its aim to lower generic prices and increase their use, but that it requires adjustments in order to be sustainable in the Netherlands as pharmacists and patients currently experience negative consequences of this policy.