The National Health Care Institute has advised the Minister of Health, Welfare and Sport (VWS) to reimburse levodopa inhalation powder (Inbrija®) from the basic health insurance package. This medicine can be used in certain patients with Parkinson's disease. If the Minister adopts our advice, levodopa inhalation powder will be included in the Medicine Reimbursement System (GVS). Only then will this medicinal product be reimbursed from the basic health insurance package.
Current state of affairs: advice 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 on whether to reimburse the medicinal product from the basic health insurance package.
Levodopa inhalation powder is intended for certain people with Parkinson's disease
Levodopa is the active substance. The brand name is Inbrija®. The medicine is a powder to breathe in using an inhaler. It can be used by people with Parkinson's disease who suffer from OFF episodes during their maintenance treatment with levodopa and dopa-decarboxylase inhibitor tablets.
An OFF episode occurs when the medication has almost worn off. The brain then produces too little dopamine. Dopamine is a ‘messenger’ that is needed to get muscles moving. For example, during an OFF episode, people with Parkinson's disease may suddenly experience stiffness, slowness and tremors.
Parkinson's disease is an incurable disease that gets progressively worse. Patients experience motion problems, such as tremors in rest, stiffness, and slower and lesser movement. Levodopa tablets in combination with a decarboxylase inhibitor are effective to treat these symptoms. This treatment creates more dopamine in the brain. However, at a later stage of the disease, the effect decreases. This often causes annoying fluctuations in the effectiveness of levodopa. These so-called motor fluctuations cause an OFF episode.
If someone with Parkinson feels an OFF episode coming on, but it is not yet time for the next levodopa tablet in combination with a decarboxylase inhibitor, the levodopa inhalation powder can be used to overcome the OFF episode.
The National Health Care Institute advice on reimbursement of levodopa (Inbrija®)
The National Health Care Institute advises the Minister of VWS to reimburse levodopa inhalation powder (Inbrija®) from the basic health insurance package. This concerns people with Parkinson's disease who are being treated with levodopa tablets and a dopa-decarboxylase inhibitor who cannot use the apomorphine injection. The advice is to include the medicinal product in Annex 1B of the GVS.
For more information on the GVS and the Lists 1A, 1B and 2, see page ‘Reimbursement of outpatient medicines'.
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 Scientific Advisory Board (WAR) advises the National Health Care Institute about the assessment. The Minister makes the final decision on whether or not to reimburse the medicinal product from the basic health insurance package.
Explanation about the reimbursement of medicinal products
Levodopa inhalation powder is an extramural medicinal product. ‘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.