Advice on the clustering of combination products and ghost clusters in GVS (part 1)

In preparation for the modernisation of the medicine reimbursement system (GVS), the Minister of Medical Care has asked Zorginstituut Nederland questions about the clustering of two categories of medicinal products, namely the combination products and the ghost clusters. Because the question is about a large number of medicinal products, it has not been possible to discuss all medicinal products in one report. We will therefore advise the Minister on these in several parts.

In this report

In this report (part 1), the National Health Care Institute provides a general approach to systematically grouping the combination products into clusters. 

The Minister has also specifically asked questions about two specific groups of combination products, namely those for antiretroviral medicinal products (HIV-inhibitors) and medicinal products for the treatment of chronic hepatitis C infection. These questions have been covered in this report.

Ghost clusters

With regard to the ghost clusters, we have done an initial exploration of the list of 64 substances with 121 article names. Ghost clusters are clusters on List 1A with only one product left. Each ghost cluster has its own context: the reasons for its existence can be diverse. This leads to an assessment per situation of how the ghost product should be replaced in the GVS after the ghost cluster has been discontinued. The discussion of (most) ghost clusters requires an individual assessment.

In this advice, we have discussed a number of products in this category. The report contains our advice on the clusters for children and combinations with medical devices or utensils. We have also denominated two medicinal products which, in our opinion, do not belong in the GVS; they are better suited to medical care as specialist medicinal products. The financial consequences of this proposal are limited.


In the course of 2021, the Zorginstituut will draw up a plan for the evaluation of the remaining (groups of) medicinal products. Given the limited capacity of the Zorginstituut, we will do this in stages. We will coordinate this with the Ministry's Department of Medicinal Products and Medical Technology.