Advice on the clustering of combination products and ghost clusters in GVS (part 2)

Advice by the National Health Care Institute (part 2)

In this advisory report (part 2), we are advising on 9 ghost clusters. These are 7 injections: Zantac®, Etalpha®, Solu Cortef®, Pneumovax®, Tramal®, Diazepam®, Temgesic®. In addition, we will discuss the De-Nol® tablet and Tramadol® suppository. 

The substantive discussion of these ghost products is set out in Annex 1. Reactions from the different parties are included in Annex 2. Based on our assessments, the National Health Care Institute has completed the following advice:

• Zantac® injection and De-Nol® tablet can be removed from the GVS.
• Etalpha®, Solu Cortef®, Pneumovax®, Tramal® and Temgesic® injections: these products can be placed on List 1B of the Rzv.
• Tramadol® suppository can be moved to the 0N02AXAO V cluster of List 1A of the Rzv.
• Diazepam® injection (DDD 10 mg parenteral) may remained in List 1A. This product, together with Temesta® injection (lorazepam; DDD 2.5 mg parenteral) can be placed together in a newly formed cluster. 

Medicine Reimbursement System (GVS)

An extramural drug (medicinal products prescribed by a physician and available at the pharmacy) is only reimbursed if it is included in the GVS. The amount of the reimbursement depends on the list the product is listed on. Interchangeable medicinal products are placed in 1 cluster on List 1A. These may be subject to a reimbursement limit. Each cluster contains at least 1 payment-free medicinal product. Unique medicinal products are listed in List 1B. The medicinal products on this list do not have a reimbursement limit.

The Minister's request for an advisory report on combination products and ghost clusters is based on the intended decision to modernise the GVS. This request is in preparation of this decision.

Combination products

Combination products (medicinal products containing more than 1 active substance in a fixed combination) have so far been frequently placed in a Y cluster or in List 1B of the GVS. The reimbursement limits for the combination products have so far been calculated differently from the reimbursement limits for the monopreparations.

With the modernisation of the GVS, the Ministry of Health, Welfare and Sport wants to also apply the traditional calculation system for medicinal products in the GVS to combination products. The guiding principle here is that, after the recalculation of the reimbursement limits, at least 1 product without additional payment becomes available.

To enable the use of the regular calculation system for combination preparations, these products must first actually be placed in one cluster. The Minister for Medical Care therefore asked the National Health Care Institute to advise which combination preparations in the GVS can be clustered together and which cannot. In the advisory report, attention should to be paid to the medicinal products for HIV and hepatitis C, which have an exemption status in the GVS.

Ghost clusters

Ghost clusters are clusters on List 1A that contain only 1 product, sometimes with an additional payment. VWS is considering eliminating the ghost clusters in the GVS by clustering the products wherever possible. This is possible if they are interchangeable with other products. The Minister has asked the National Health Care Institute to advise on the interchangeability of products currently in a ghost cluster.

This report is a summary of recommendations by the National Health Care Institute. The original text is in Dutch.