Monitoring the vitamin D package measure

Reason: follow-up on the effects of the 2022 advice

On the advice of the National Health Care Institute, all vitamin D products containing cholecalciferol or calcifediol were removed from the GVS as of 1 January 2023. These are medicinal products used to prevent or treat vitamin D deficiency. According to the National Health Care Institute, it is not necessary to reimburse these products because most people can pay the costs themselves. Part of the advice is to monitor the practical effects of this measure on the use of vitamin D and patient compliance. By patient compliance we mean that people are using their medications properly as indicated. That is why Nivel studied the practical effects in the first half of 2023, as commissioned by the National Health Care Institute. 

Study aimed at vulnerable people

The research focused on a group of vulnerable people who received reimbursement for their vitamin D in 2022 and who may have been hit extra hard by the package measure. In 2022, 1.5 million people were reimbursed for vitamin D. To determine exactly who is part of the group of vulnerable people, Nivel spoke to several healthcare professionals: pharmacists, general practitioners and a district nurse. From this, the following groups of people are defined as vulnerable:

• people with difficulty keeping oversight of their medicines;
• people with osteoporosis;
• people with a language barrier or an immigration background;
• people with a low level of education;
• people with low socio-economic status;
• people with generally ill health;
• people with limited health literacy;
• people with low-level literacy.

People belong to this vulnerable group if they have at least 1 of these characteristics. This was selected because people often have more than 1 issue.

Study results: most people continued taking vitamin D

The study shows that a large proportion of vulnerable people have continued to take vitamin D:

• 65% continued to use vitamin D and now pay for it themselves. The main reason is that people consider vitamin D necessary for their health. 
• 5% stopped taking vitamin D. Half of them say they stopped because they cannot afford it. 
• 20% still had a supply of vitamin D and continued to use it. Of this group, 70% say they will continue taking vitamin D when they run out of supply. 6 to 7% say they will stop.
• The remaining 10% did not enter any useful information.

The study also shows that patient compliance in vulnerable vitamin D users is not optimal in 2023: some people take less vitamin D than they should. However, that was already the case in 2022, meaning that patient compliance has not changed as a result of the package measure. 

Conclusion

The National Health Care Institute concludes that the results of the study do not change our 2022 advice not to reimburse vitamin D from the Medicine Reimbursement System. In this advice, the National Health Care Institute described the expectation that most people who use prescription medicines containing vitamin D can switch to a daily dose of a over the counter product and a small proportion will stop taking it. The results of the study confirm this expectation. In 2021, the reimbursement of vitamin D products from the GVS cost approximately €129 million. We can save that money and spend it on other healthcare that people cannot afford themselves. Of course, the National Health Care Institute also recognises that people in poverty cannot afford the relatively low cost of vitamin D. It would therefore be good if a solution could be found outside the health care insurance.

In addition, the National Health Care Institute advises the Minister of Health, Welfare and Sport to improve and repeat the public information campaign on the correct use of vitamin D. Nivel's study also shows that some people, such as those with limited health literacy, still have difficulty in finding a suitable vitamin D product. These people are, for example, people with limited health literacy.

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