Preferred medicines policy
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Preferred medicines
Medicines are often available in several varieties and under several brand names behind the pharmacy counter. If they have the same active ingredient and the same strength, they work in the same way. But they look different. The price is also different. In such cases, we choose which brand of medicine will be reimbursed. Namely, the medicine with the lowest price. This is our preferred medicine. We will then only reimburse this variant.
Why a preference policy?
Not all health insurers have a preference policy for medicines. HollandZorg has made a conscious decision to do so. By choosing the more affordable versions of medicines, we keep healthcare affordable and accessible for everyone. Premiums rise less rapidly and, as a patient, you pay the lowest price when the medicine is covered by your excess.
What does your doctor prescribe?
Your doctor writes the active ingredient you need on the prescription, rather than the brand name of the medicine. Your pharmacist will give you the preferred medicine based on the active ingredient. Only if your GP indicates that it is medically necessary for you to receive a different brand may the pharmacy deviate from our preference policy.
The same medicine, different packaging
Your pharmacy may provide you with medicines that have a different name or packaging than you are used to. The medicine may also look different, for example, a pill with a different colour or shape. However, there is no need to worry. The medicine you receive from your pharmacy has the same effect as the medicine you used previously.
How is the preferred medicine chosen?
The Medicines Evaluation Board (CBG) checks medicines for quality, efficacy and safety. The Minister of Health, Welfare and Sport (VWS) determines whether medicines are interchangeable, i.e. whether they have the same active ingredient, strength, effect and dosage form. From those checked medicines, we choose the medicine with the lowest price as the preferred medicine.
No excess
The costs for preferred medicines are not covered by your compulsory and voluntary excess. When dispensing a medicine, the pharmacy also charges dispensing costs. These costs are covered by your excess. These costs are a fee for the work that the pharmacy does for you. This includes checking the prescription and dispensing the medicine, updating your medication file and checking whether the medicine can be used at the same time as any other medicines you are taking.
Fewer changes
Did you previously receive a different medicine from your pharmacy on a regular basis? Thanks to the preference policy, the choice of a particular medicine is fixed for a longer period of time, so you do not have to change medicines.
What if you cannot or do not want to use the preferred medicine?
You are entitled to reimbursement for the preferred medicine. You do not pay any excess for preferred medicines. You are not entitled to reimbursement for another medicine, unless there is a “medical necessity” or a “logistical necessity”.
Medical necessity
Medical necessity applies if it is medically irresponsible for you to use the preferred medicine. Your prescriber may only state medical necessity on the prescription if the prescriber can substantiate that necessity. The pharmacy will check whether medical necessity applies. In case of doubt, the pharmacy and the prescriber will consult on the medical necessity. If the prescriber and the pharmacy cannot reach agreement, the pharmacist's opinion will prevail, unless we decide otherwise.
Is there a medical necessity? Then you will not receive the preferred medicine. In that case, your pharmacy will choose another medicine with the lowest price based on the prescribed active ingredient and the prescriber's explanation. Before you receive the medicine of your choice, you must have tried at least two cheaper medicines with the same active ingredient. These medicines must be available and medically acceptable to you.
Logistical necessity
There is a logistical necessity if the preferred medicine is unavailable in the Netherlands for a longer period of time and no other preferred medicine has been designated in the meantime. Is there a logistical necessity? If so, your pharmacy will choose which other medicine you will receive based on the active ingredient prescribed by the prescriber and the accompanying explanation.