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Henk Eleveld - Selling Sickness 2010


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Henk Eleveld - Selling Sickness 2010

  1. 1. The Dutch preference policy and rational prescribing<br />Henk Eleveld, Pharmacist<br />Contractmanager pharmacy Menzis<br />Selling sickness, 8 October 2010<br />
  2. 2. Contents of the presentation<br />Menzis<br />Medicines policy<br />Preference policy<br />
  3. 3. Menzis’ Key Characteristics<br /><ul><li>The fourth largest health insurer in the Netherlands
  4. 4. 2,1 million lives insured, in Eastern and Northern areas market shares up to 65%
  5. 5. Market share in The Hague 30% after acquisition of Azivo
  6. 6. Anderzorg is an internet brand with 129.000 lives and lowest price promise
  7. 7. Total premium income 4.6 billion
  8. 8. Mutual insurer: members / customers are ‘shareholders’ </li></li></ul><li>Menzis’ responsibility<br />Not to exclude but to encourage good quality (TopCare)<br />To invest in care innovation (e-Health concepts)<br />To ensure that strongly integrated primary care is available nearby<br />To provide care services (Better Living, exercise programmes for people on social assistance)<br />To use premiums efficiently (because the employer is obliged to pay 50%)<br />To promote realistic prices for medicines (Preference policy) and help rational prescribing by doctors<br />
  9. 9. Contents of the presentation<br />Menzis<br />Preference policy<br /><ul><li> Medicines policy</li></li></ul><li>Government medicines policy<br />Up to 1988: Capitation fees and a ban on bonuses and discounts (‘B and D’)<br />1991: Simons: rate for pharmacists too low and compensation by means of ‘B and D’ possible (fl. 300,000 per pharmacy)<br />2003: The ‘de Geus’ measure for skimming off ‘B and D’ was forbidden by the courts<br />2004-2009 Covenants + transitional agreement: skimming off of ‘B and D’ to be reduced to ‘0’ in instalments <br />Result: Realistic generic price decrease but volume of ‘B and D’ increased to € 400,000 per pharmacy in 2007 (approx. 2000 Pharmacies) <br />
  10. 10. Contents of the presentation<br />Menzis<br />Medicines policy<br />Preference policy<br />
  11. 11. Preference policy<br />Medicines no longer under patent protection were relatively expensive for consumers in the Netherlands (price difference with branded drugs < 2%)<br />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!<br />They did not have to pass this on to the insured. <br />The Healthcare Insurance Act enables preference policy;<br />
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  14. 14. What is preference policy?<br />Once the patent on a medicine lapses, several manufacturers make an identical medicine.<br />Preference policy finds the cheapest medicine based on the active ingredient in question.<br />All manufacturers are invited to submit their price on a reference date.<br />The manufacturer with the lowest price on the reference date = preferred for a period of 1 year.<br />Healthcare insurer designates only the lowest-priced product for reimbursement.<br />So: market share in exchange for the lowest price!<br />Very successful since July 2008<br />
  15. 15. 500 million euro annually<br />€ 30 per insured per year<br />40 mg simvastatin<br />Nov. 2007: € 15.76<br />July 2008: € 0.88<br />July 2010: € 0.63<br />
  16. 16. Apothekers in actie tegen bemoeizucht verzekeraars<br />Trouw 6 december 2007<br />'Stijgende kosten door goedkope medicijnen'<br />DVHN | Gepubliceerd op 21 februari 2007, 21:42<br />
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  18. 18. What does this mean for our insured's?<br />Menzis is not taking the doctor’s place <br />Absolutely safe medicines (the Medicines Evaluation Board, CBG)<br />No therapeutic substitution (the same active ingredient is involved)<br />Pharmacists often switch medicines themselves<br />The more expensive medicines are reimbursed in the event of medical necessity<br />No conflict with pharmacists or the pharmaceutical industry,<br /> but fighting on behalf of the patients and those paying the premiums!<br />Not simply a harsh cutbacks campaign<br />
  19. 19. Preference policy expanded as from 2009 and 2010!<br />Not the end but the means<br />Objective: transparency and realistic market prices without bonuses<br />We have not heard of a better plan yet<br />Preference policy is the only instrument so far<br />In 2009/2010 expansion with more medicines that are no longer under patent <br />Efficient prescription (by doctors in hospitals too)<br />
  20. 20. Future of preference policy<br />Biosimilars<br />1,2 billion € off patent products in next 5 years<br />Expansion in other European Countries?<br />Problem is the law in those countries<br />Analysis of the law is required in each country.<br />
  21. 21. Rational prescribing<br />Once there are differences in prices, make use of them.<br />Make use of guidances of doctors. Choose the rational product.<br />Make contracts with doctors and hospitals to prescribe those most cost effective drugs op population base!<br />Here are the results:<br />
  22. 22. Rational prescribing<br />