Petra van Holst, CEO of Zorgverzekeraars Nederland (ZN) “Dutch insurers apply AIM’s fair pricing calculator by default when negotiating drug prices with companies”


High medicines prices are now a reality across the EU, leading to inequalities of access to medicines, or even to no access in some European countries. This is a major challenge to our solidarity-based healthcare systems, one which is not going to recede as long as current medicines price-setting principles are not radically changed.

The Netherlands is one of the most active European countries regarding the control of medicines prices. Petra van Holst, CEO of Zorgverzekeraars Nederland (ZN), our Dutch member, took the time to answer our questions on the situation in her country, where healthcare insurers have proactively implemented a number of initiatives to better control increasing prices of medicinal products.

Ms van Holst, can you explain the trend regarding affordability of medicinal products in the Netherlands ? Does it have an impact on patients’ access to medicinal products ?

This dossier is characterized by high prices, rapidly increasing expenditures and continuous developments and innovations. Spending on medicinal products in the Netherlands has increased in recent years by an average of 7% per year. This increase is greater than the growth of other health expenditures like hospital care. As a result, this money cannot be used for personnel or innovation. This puts pressure on the sustainability of our health care system.

When health insurers spend unnecessarily on medicinal products that are ineffective, the patient access to these products can be compromised. ZN wants to work toward prices with a socially acceptable level and that are cost effective so that delays in the admission and reimbursement of drugs in the Netherlands can be avoided.

What is ZN’s role regarding access to medicinal products?

ZN is the umbrella organisation of Dutch health insurers. Within our organisation, health insurers’ overall vision is to work together – whenever possible – to ensure that all treatments with hospital medicinal products within the insured package are and remain (cost) effective, accessible and affordable for all patients. Health insurers have for instance established a joint purchasing association (the Clean Team) for this purpose, that makes financial agreements with pharmaceutical companies. It addresses in particular medicines for which there are few or no competing products available and where major accessibility and affordability issues exist. We are also trying to reach this together with other stakeholders and healthcare professionals.

In addition, ZN has a committee that is called the CieBAG (the Add-on Medicines Evaluation Committee) that actively assesses new medicinal products to see whether they comply with the latest scientific and practical standards.

Ms van Holst, what does the concept of fair pricing mean to you ? Has the fair pricing calculator and model made a difference in your work on the pricing and reimbursement of medicinal products ?

There is no clear consensus on the concept of fair prices for medicines because this can be approach this from multiple angles. That said, the fair price calculator gives insurers tools to be more comfortable about the reference price and more understanding of what the target price for a medicinal product should be because it helps to clarify the structure of price components. Application of the fair pricing calculator leads to pharmaceutical companies having to be more transparent about these components.

The Clean Team applies the fair price calculator by default when negotiating drug prices with pharmaceutical companies. Currently, the Clean Team has over 40 agreements with pharmaceutical companies.

Can countries reach fair medicines prices alone in your opinion? How could the revision of the pharmaceutical legislation bring conditions conducive to fairer medicines prices and a better management of pharmaceutical products in your country and in general ?

To a certain extent it is possible for countries to achieve fair prices on their own, but it is more effective to work together in terms of changing European legislation.

At this moment the new European patent legislation does not provide enough relief for the Netherlands nor for other countries when it comes to ultimately achieving fair prices for patients. We even see some risks within the new pharmaceutical legislation of longer protections and thus high prices that eventually may lead to delays in access to medicinal products. We do think that countries should cooperate more to improve the legislation and to enshrine more transparency about price structure in law. We also think more cooperation is needed to ensure, for example, that cost-effectiveness becomes a more relevant part of the review of registration dossiers by the European Medicine Agency (EMA).