GVS advice nirmatrelvir/ritonavir (Paxlovid®) for the treatment of COVID-19
The National Health Care Institute has assessed whether nirmatrelvir/ritonavir (Paxlovid®) can be included in the Medicine Reimbursement System (GVS). This medicinal product can be used for the treatment of adults with a coronavirus infection (COVID-19) and a very high risk of a severe course of the disease. The National Health Care Institute advises the Minister for Health, Welfare and Sport to reimburse Paxlovid for medical high-risk groups as described in the Dutch physicians' guidelines.
Coronavirus infection
The National Health Care Institute concludes that nirmatrelvir/ritonavir has added value in the treatment of adults with a coronavirus infection (COVID-19) who do not require oxygen supplementation and are at a very high risk of severe disease progress. They must start the 5-day treatment as soon as possible after the coronavirus has been detected, and in any case within 5 days of the onset of symptoms, since Paxlovid will then reduce the risk of hospitalisation or death for this group of patients.
Recommendations from the National Health Care Institute
The National Health Care Institute advises the Minister to reimburse Paxlovid only for medical high-risk groups as described in the Dutch physicians' guidelines. In one year's time, the National Health Care Institute will evaluate whether a reassessment of the coronavirus medicinal product is necessary.
To limit the effects of a possible autumn wave, the National Health Care Institute wants the medicinal product to become available to these patients quickly. The National Health Care Institute has therefore granted a provisional exemption from cost-effectiveness analysis. This means that the National Health Care Institute will assess the extent to which the effects of the medicinal product justify the price at a later stage.
In the advice to the Minister, the National Health Care Institute emphasizes that the treatment price of €1242 requested by the manufacturer is much higher than the amounts mentioned in the media about the price in other countries. For example, the US government is allegedly paying $500 per treatment.
Medicine Reimbursement System (GVS)
Nirmatrelvir/ritonavir is an extramural drug. Extramural drugs are medicinal products for home use, available at the pharmacy on prescription from a physician. They will only be reimbursed from the basic health care package if they are listed in the GVS. The amount of the reimbursement depends on the list the product is on. Interchangeable medicinal products are clustered in List 1A. These may be subject to a reimbursement limit. Unique medicinal products are listed in List 1B. There is no reimbursement limit for these products. Additional conditions may apply for reimbursement. In that case, a medicinal product is also listed on List 2.
The Scientific Advisory Board (WAR) advises the National Health Care Institute on the assessment. Based on the assessment, the National Health Care Institute sends an advisory report to the Minister of Health, Welfare and Sport. The Minister makes the final decision whether or not to reimburse the medication from the basic health care package.