The National Health Care Institute has advised the Minister of Health, Welfare and Sport (VWS) to extend the List 2 conditions for sildenafil and tadalafil to include people with secondary Raynaud’s phenomenon, a condition in the blood vessels. Sildenafil and tadalafil are already in the Medicine Reimbursement System (GVS) and are reimbursed to certain men with erectile dysfunction and certain patients with pulmonary arterial hypertension (PAH). If the minister adopts our advice, the medicinal products will also be reimbursed for people with secondary Raynaud's phenomenon.
Current state of affairs: advisory report sent to the minister
The National Health Care Institute has sent this advice to the Minister of Health, Welfare and Sport (VWS). The Minister makes the final decision whether or not to extend the conditions of reimbursement.
Sildenafil and tadalafil are intended for certain people with erectile dysfunction, PAH or secondary Raynaud's phenomenon
Sildenafil and tadalafil are the active substances. The medicinal product is a tablet.
The medicine can be used for:
- certain men with erectile dysfunction.
- certain patients with pulmonary arterial hypertension (PAH), the narrowing of the pulmonary artery and the arteries around it. This causes the blood pressure to become too high. The heart must then work harder to get the blood to flow through the pulmonary artery. Eventually, people with PAH suffer heart failure.
- certain people with secondary Raynaud's phenomenon. That is a condition in the blood vessels, often affecting the fingers and toes. Because the blood vessels constrict, blood is less able to flow through them. This can lead to pain and sometimes to sores and wounds.
Advice from the National Health Care Institute on extension of the reimbursement conditions for sildenafil and tadalafil
The National Health Care Institute advises the Minister of Health, Welfare and Sport to expand the reimbursement conditions for sildenafil and tadalafil to people with secondary Raynaud's phenomenon. These are the so-called List 2 conditions.
For more information on the GVS and Lists 1A, 1B and 2, see the page ‘Reimbursement of outpatient medicines'.
Expansion of the conditions for reimbursement of sildenafil and tadalafil
Sildenafil and tadalafil are already included in the GVS for men with erectile dysfunction and patients with PAH. With the advice of 10 October 2025, we advise the Minister to extend the List 2 conditions for secondary Raynaud's phenomenon as follows:
Only for insured persons who:
- Suffer from pulmonary arterial hypertension New York Heart Association Class II and who are prescribed ambrisentan, bosentan, macitentan, riociguat, selexipag, sildenafil or tadalafil for this
- Suffer from pulmonary arterial hypertension New York Heart Association class III or IV and who are prescribed:
- any of the oral medicinal products ambrisentan, bosentan, macitentan, riociguat, selexipag, sildenafil or tadalafil, or a combination of two oral medicinal products from different pharmacological groups.
- Suffer from secondary Raynaud’s phenomenon associated with connective tissue disease and who are prescribed sildenafil or tadalafil and are insufficiently responsive to or cannot be treated with dihydropyridine calcium channel blockers.
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 of Health, Welfare and Sport (VWS) asks the National Health Care Institute to carry out an assessment. The final decision as to whether or not reimbursement from the basic healthcare package will take place lies with the Minister.
Explanation about the reimbursement of medicinal products
Sildenafil and tadalafil are extramural medicinal products. ‘Extramural’ means medicines for home use that can be obtained at the pharmacy with a prescription from a physician. They are only reimbursed from the basic healthcare package if they are listed in the GVS.