The National Health Care Institute has advised the Minister of Health, Welfare and Sport (VWS) to maintain the current reimbursement conditions for medicinal products for allergies. This means that these products are only insured care for people with long-term allergic symptoms. And not for people with seasonal or short-term symptoms. The National Health Care Institute calls on physicians, pharmacists and health insurance companies to strictly comply with these reimbursement rules. At present, there are many people who receive reimbursement outside the rules.
Reason: request from the Minister
At the request of the Minister of VWS, the National Health Care Institute will assess whether it is necessary to continue to reimburse self-care medicinal products from the Medicine Reimbursement System (GVS). Self-care medicinal products are medicinal products that people can buy without prescription. They can be bought at a pharmacy, drugstore or supermarket. The reimbursement rule also applies to other medicinal products that are virtually equivalent to the self-care medicinal product. In addition to self-care products, there are also prescription medicinal products. These are medicinal products that people are prescribed by a physician. By only reimbursing care that is necessary to be insured, we keep the basic health insurance package accessible and affordable. Making sure that everyone in the Netherlands who needs that care is also able to get it, now and in the future.
Medicinal products for allergies are intended for various symptoms
In this report we discuss 2 groups of medicinal products: antihistamines and cromones. These medicinal products are commonly used to relieve nasal and eye symptoms in allergic rhinitis and allergic conjunctivitis. Allergic rhinitis is inflammation of the nasal mucosa by a substance that causes allergy. In allergic conjunctivitis, the connective or mucous membrane of the eye is inflamed by an allergen. People can get these infections as a result of hay fever, for example. Antihistamines can also be used in case of itching or nettle rash, also called hives or urticaria. These medicinal products can be used as tablets, capsules, oral solutions, nasal sprays, or eye drops.
Advice National Health Care Institute: only necessary for long-term symptoms
The National Health Care Institute concludes that medicinal product for allergies may continue to be reimbursed for people with chronic symptoms. Chronic means they need the medicine for a long time. In this case, more than 6 months in succession. For them, the costs can be high. In the case of seasonal or short-term symptoms, the user pays for the medicinal product: the medicines are not considered 'necessary to insure care'. The burden of disease and costs are low. The National Health Care Institute's conclusion is in line with the already existing reimbursement conditions for medicinal products for allergies.
Call on stakeholders: implement reimbursement rules correctly
In practice, it appears that two-thirds of the users of medicinal products for allergies receive reimbursement outside the reimbursement rules. The National Health Care Institute therefore expects general practitioners, pharmacists and health insurance companies to strictly comply with the reimbursement rules for medicinal products for allergies. This means that physicians and pharmacists need to better assess whether a specific case is a case of long-term use. And that they clearly communicate this with patients. Health insurance companies have the task of verifying that physicians and pharmacists meet these conditions.
The National Health Care Institute will speak with representatives of general practitioners and pharmacists to support them in the implementation of the reimbursement rules. In practice, it sometimes appears difficult to make a proper preliminary assessment of whether people need the medicines short or long-term. The National Health Care Institute will continue to actively monitor this issue and will review in 2028 whether the reimbursement rules are being properly complied with or whether follow-up action is needed.
Conditions for reimbursement of medicinal products for allergies
The following conditions for reimbursement are included in the Medicine Reimbursement System (GVS):
Only for an insured person who, according to the prescription, has been prescribed the medicinal product for more than 6 months continuously and for whom the medicinal product has been prescribed for the treatment of a chronic condition, unless it is a new medication for the insured person.
For more information about the GVS, see ‘Reimbursement of outpatient medicines’.