Advice - Reimburse codeine only for the treatment of severe, chronic diarrhoea
The National Health Care Institute has advised the Minister for Medical Care to reimburse codeine only for the treatment of severe, chronic diarrhoea. We recommend that codeine should no longer be reimbursed for dry cough, pain and acute diarrhoea. If the Minister takes our advice, codeine will only remain included in the Medicine Reimbursement System (GVS) for severe, chronic diarrhoea.
Codeine is intended for people with chronic diarrhoea
Codeine is the active substance. The medicinal product is a tablet. It can be used for dry cough, pain or diarrhoea.
Advice from the National Health Care Institute on the reimbursement of codeine
The National Health Care Institute advises the Minister of Medical Care that codeine should be included in the basic health care package for the treatment of severe, chronic diarrhoea. Chronic diarrhoea lasts longer than 14 days or often recurs. If loperamide is insufficiently effective, patients can use codeine. The National Health Care Institute concludes that codeine for this group of people must be insured and should remain in the basic health care package, given that the cost of long-term treatment with codeine is high. This is due on the one hand to the long duration of the treatment, and on the other hand to the high dosage.
The National Health Care Institute recommends that codeine no longer be reimbursed for cough, pain and acute diarrhoea, because it has concluded that codeine for these symptoms is negative for need for insurance. The reasons for this are:
- The conditions with short-term symptoms have a very low burden of disease.
- The costs of short-term treatment are low and can be borne by the user. On average, the costs are around €22 per person per year.
- In case of acute diarrhoea, treatment with medication is usually not necessary. Furthermore, treatment with codeine has not been shown to relieve coughing or pain. However, treatment can cause side effects. Therefore, in the guidelines of Dutch physicians, codeine is not recommended for these symptoms.
For more information on the GVS and the Lists 1A, 1B and 2, see page ‘Reimbursement of extramural drugs (GVS)’.
Conditions for reimbursement of codeine
The following conditions apply for reimbursement:
Only for an insured person with chronic diarrhoea who cannot be treated with loperamide because loperamide has been insufficiently effective or because loperamide cannot be used due to a contraindication or intolerance.
More information or questions?
If you have any questions about this advice, please send your question to the National Health Care Institute via warcg@zinl.nl. If you have questions about the reimbursement of a medicinal product, the personal expenses or whether you should pay a contribution, please ask your health insurance provider.
How did the advice come about?
The Insured Package Advisory Committee (ACP) advises the National Health Care Institute about the assessment. The Minister makes the final decision whether or not to reimburse the medication from the basic health care package.
Explanation about the reimbursement of medicinal products
Codeine is an extramural medicinal product. Extramural means: medicines for home use that can be obtained at the pharmacy with a prescription from a physician. They are only reimbursed from the basic health care package if they are listed in the GVS.