The National Health Care Institute has advised the Minister of Health, Welfare and Sport (VWS) to reimburse the PCV20 vaccine (Prevenar 20®) from the basic healthcare package. This vaccine can prevent diseases caused by a bacterium called pneumococcus. This bacterium can cause diseases such as pneumonia or meningitis. We have evaluated the vaccine specifically for high-risk groups. If the minister adopts our advice, the PCV20 vaccine will be included in the Medicine Reimbursement System (GVS). Only then will this vaccine be reimbursed from the health care insurer's basic healthcare package. We do recommend additional conditions for reimbursement.
Current state of affairs: advisory report sent to the Minister
The National Health Care Institute has sent this advice to the Minister of VWS. The Minister makes the final decision whether or not to reimburse the medicinal product from the basic healthcare package.
PCV20 is intended for the prevention of pneumococcal disease in high-risk groups
The PCV20 vaccine contains pieces of the bacteria that cause pneumococcal disease. These pieces are made harmless and do not make you sick. The brand name is Prevenar 20®. The vaccine is administered with an injection.
The vaccine can be used to prevent pneumonia and invasive disease caused by the bacterium Streptococcus pneumoniae in people who fall into high-risk groups. Pneumonia is an inflammation of the lungs. In invasive disease, the bacterium has also penetrated the bloodstream or other tissues, making the person seriously ill. Streptococcus pneumoniae are bacteria that can cause pneumococcal disease. High-risk patients have a disease or are receiving treatment that reduces their immune response. For example, people who are receiving a stem cell transplant or people who do not have a spleen. This makes them more susceptible to infectious diseases, such as pneumonia or shingles. The consequences of an infectious disease can be very serious. The PCV20 vaccine is designed to protect against 20 different types of pneumococcal bacteria. Pneumococci can lead to life-threatening complications such as meningitis, blood poisoning (sepsis) and severe pneumonia.
The marketing authorisation holder has requested reimbursement for the active immunisation to prevent invasive disease and pneumonia caused by Streptococcus pneumoniae in high-risk groups, as defined in the guideline of the National Coordination Centre for Communicable Disease Control of the National Institute for Public Health and the Environment (LCI-RIVM).
Advice from the National Health Care Institute on the reimbursement of the PCV20 vaccine (Prevenar 20®)
The National Health Care Institute advises the Minister of Health, Welfare and Sport to reimburse the PCV20 vaccine (Prevenar 20®) from the basic healthcare package. The advice is to include the medicinal product in List 1B of the GVS. The PCV20 vaccine (Prevenar 20®) is subject to certain additional conditions, the so-called List 2 conditions.
For more information on the GVS and the Lists 1A, 1B and 2, see page ‘Reimbursement of outpatient medicines’.
Conditions for reimbursement of PCV20 vaccine (Prevenar 20®)
Only for insured persons:
- who fall into a medical high-risk group and have been designated in accordance with the (international) guidelines accepted in the Netherlands by the relevant professional groups.
More information or questions?
If you have any questions about this advice, please send your question to the National Health Care Institute via warcg@zinl.nl. If you have questions about the reimbursement of a medicinal product, the personal expenses or whether you should pay a contribution, please ask your health insurance provider.
How did the advice come about?
The Minister makes the final decision whether or not to reimburse the medicinal product from the basic healthcare package.
Explanation about the reimbursement of medicinal products
The PCV20 vaccine is an extramural medicinal product. Extramural means: medicines for home use that can be obtained at the pharmacy with the prescription from a physician. They are only reimbursed from the basic healthcare package if they are listed in the GVS.