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Henk Eleveld - Selling Sickness 2010

Henk Eleveld - Selling Sickness 2010






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    Henk Eleveld - Selling Sickness 2010 Henk Eleveld - Selling Sickness 2010 Presentation Transcript

    • The Dutch preference policy and rational prescribing
      Henk Eleveld, Pharmacist
      Contractmanager pharmacy Menzis
      Selling sickness, 8 October 2010
    • Contents of the presentation
      Medicines policy
      Preference policy
    • Menzis’ Key Characteristics
      • The fourth largest health insurer in the Netherlands
      • 2,1 million lives insured, in Eastern and Northern areas market shares up to 65%
      • Market share in The Hague 30% after acquisition of Azivo
      • Anderzorg is an internet brand with 129.000 lives and lowest price promise
      • Total premium income 4.6 billion
      • Mutual insurer: members / customers are ‘shareholders’
    • Menzis’ responsibility
      Not to exclude but to encourage good quality (TopCare)
      To invest in care innovation (e-Health concepts)
      To ensure that strongly integrated primary care is available nearby
      To provide care services (Better Living, exercise programmes for people on social assistance)
      To use premiums efficiently (because the employer is obliged to pay 50%)
      To promote realistic prices for medicines (Preference policy) and help rational prescribing by doctors
    • Contents of the presentation
      Preference policy
      • Medicines policy
    • Government medicines policy
      Up to 1988: Capitation fees and a ban on bonuses and discounts (‘B and D’)
      1991: Simons: rate for pharmacists too low and compensation by means of ‘B and D’ possible (fl. 300,000 per pharmacy)
      2003: The ‘de Geus’ measure for skimming off ‘B and D’ was forbidden by the courts
      2004-2009 Covenants + transitional agreement: skimming off of ‘B and D’ to be reduced to ‘0’ in instalments
      Result: Realistic generic price decrease but volume of ‘B and D’ increased to € 400,000 per pharmacy in 2007 (approx. 2000 Pharmacies)
    • Contents of the presentation
      Medicines policy
      Preference policy
    • Preference policy
      Medicines no longer under patent protection were relatively expensive for consumers in the Netherlands (price difference with branded drugs < 2%)
      Dutch pharmacists made very high margins (compared with the rest of Europe) on unbranded medicines: they frequently earned money by substituting generic medicines for branded counterparts!
      They did not have to pass this on to the insured.
      The Healthcare Insurance Act enables preference policy;
    • What is preference policy?
      Once the patent on a medicine lapses, several manufacturers make an identical medicine.
      Preference policy finds the cheapest medicine based on the active ingredient in question.
      All manufacturers are invited to submit their price on a reference date.
      The manufacturer with the lowest price on the reference date = preferred for a period of 1 year.
      Healthcare insurer designates only the lowest-priced product for reimbursement.
      So: market share in exchange for the lowest price!
      Very successful since July 2008
    • 500 million euro annually
      € 30 per insured per year
      40 mg simvastatin
      Nov. 2007: € 15.76
      July 2008: € 0.88
      July 2010: € 0.63
    • Apothekers in actie tegen bemoeizucht verzekeraars
      Trouw 6 december 2007
      'Stijgende kosten door goedkope medicijnen'
      DVHN | Gepubliceerd op 21 februari 2007, 21:42
    • What does this mean for our insured's?
      Menzis is not taking the doctor’s place
      Absolutely safe medicines (the Medicines Evaluation Board, CBG)
      No therapeutic substitution (the same active ingredient is involved)
      Pharmacists often switch medicines themselves
      The more expensive medicines are reimbursed in the event of medical necessity
      No conflict with pharmacists or the pharmaceutical industry,
      but fighting on behalf of the patients and those paying the premiums!
      Not simply a harsh cutbacks campaign
    • Preference policy expanded as from 2009 and 2010!
      Not the end but the means
      Objective: transparency and realistic market prices without bonuses
      We have not heard of a better plan yet
      Preference policy is the only instrument so far
      In 2009/2010 expansion with more medicines that are no longer under patent
      Efficient prescription (by doctors in hospitals too)
    • Future of preference policy
      1,2 billion € off patent products in next 5 years
      Expansion in other European Countries?
      Problem is the law in those countries
      Analysis of the law is required in each country.
    • Rational prescribing
      Once there are differences in prices, make use of them.
      Make use of guidances of doctors. Choose the rational product.
      Make contracts with doctors and hospitals to prescribe those most cost effective drugs op population base!
      Here are the results:
    • Rational prescribing