Package advice vitamin D
The National Health Care Institute recommends that all colecalciferol-containing medicinal products and calcifediol be removed from the GVS. This means that they are no longer included in the basic health care package. The National Health Care Institute will monitor whether this decision has consequences for the use of vitamin D. This advice is an addition to a prior advice by the National Health Care Institute to the Minister of Health, Welfare and Sport (VWS). In May 2022, the Minister of VWS agreed with the advice to remove all colecalciferol-containing medicinal products from the GVS.
Contents of the National Health Care Institute's advice
The National Health Care Institute recommends that all colecalciferol-containing medicinal products and calcifediol be removed from the GVS. These are the following (groups of) medicinal products:
- the single products with colecalciferol (ATC code: A11CC05);
- the fixed combination preparations of colecalciferol/calcium (A12AX);
- the fixed combination preparations of alendronic acid/colecalciferol (M05BB03) and alendronic acid/calcium carbonate/colecalciferol (M05BB05);
- the product calcifediol (A11CC06).
Reason for the advice
Based on a package advice from 2016, a few vitamin D-containing medicinal products have been removed from the GVS. Research by the Netherlands Institute for Health Services Research (Nivel) has shown that for users of vitamin D medicinal products that were removed from the package since 2019 as they could come at own expense, substitution has taken place for vitamin D medicinal products that are still reimbursed via the basic health care package. As a result, the costs for vitamin D medicinal products have not decreased in recent years, but have even increased. Therefore, the Minister of VWS has requested the National Health Care Institute to advice them on vitamin D-products that are still being reimbursed from the GVS.
Colecalciferol (vitamin D3) in low dose is available over the counter as a self-care product at the chemist's or supermarket. In addition, there are colecalciferol medicinal products that are prescribed by a physician and delivered through the pharmacy (high dose, mostly weekly or monthly dosage). At a standard dose of 800 international units (IU; 20 micrograms) per day, vitamin D is available for sale as a self-care product from € 7.30 per person per year. A treatment with colecalciferol on prescription costs on average € 79 per person per year. The costs of vitamin D through reimbursement from the GVS is therefore on average ten times higher than that of a comparable product purchased over the counter. A total withdrawal of all cholecalciferol-containing medicinal products (and calcifediol) from GVS leads to an annual saving of € 129 million on the pharmaceutical budget. For society as a whole, this would mean considerable savings.
Extension List 2 conditions for other vitamin D
In addition, the National Health Care Institute recommends that List 2 of the Health Insurance Regulation be extended with a new component. This point can be worded as follows: