Medicinal care

When will you qualify for reimbursement?

Under the HollandZorg public healthcare insurance, you will qualify for the reimbursement of:

The following registered medicines, subject to authorisation by us:

• Registered medicines that are indicated in Appendix 1 (but not in Appendix 2) of the Healthcare Insurance Regulations (Regeling zorgverzekering);
• medicines that are indicated in Appendix 2 of the Healthcare Insurance Regulations.

The registered medicines authorised by us are specified in the Pharmacy Regulations.

• The following non-registered medicines:
  
  • medicines that have been prepared on a small scale by or on the instructions of the dispensing chemist, in his own pharmacy;
  • medicines which, following prior consent of the Public Health Supervisory Service and in accordance with rules to be stipulated ministerial regulation, are delivered following an order placed at the initiative of a doctor and which are intended for your use under his supervision, if:

1. these medicines have been prepared in the Netherlands by a manufacturer with a licence for preparing medicines pursuant to the Medicines Act (Geneesmiddelenwet), and prepared in accordance with the specifications of that doctor; or
2. these medicines are sold in another EU country or in a third country, and are imported into Dutch territory at the request of that doctor if you suffer from an illness suffered by no more than 1 in 150,000 inhabitants in the Netherlands;
3. these medicines are sold in another EU country or in a third country and are imported into Dutch territory as a replacement medicine on account of a shortage of medicines;

• medicines for which the Board has granted a trade licence for the assessment of medicines for public health reasons, if those medicines are not sold in the Netherlands but are sold in another EU country as a replacement medicine on account of a shortage of medicines.
• Dietary preparations as referred to in Appendix 2 of the Healthcare Insurance Regulations.

Medicinal care also includes the advice and support which dispensing chemists generally provide for the assessment and responsible use of prescribed medicines.

Read the HollandZorg Conditions of Insurance for further information about the reimbursement of medicines under the public healthcare insurance, as referred to above.

Medicines we do not reimburse

By virtue of the public healthcare insurance, you are not entitled to:

• medicines to prevent travel sickness;
• medicines for research;
• medicines that are (virtually) equivalent to a registered medicine, but not included in appendix 1 of the Healthcare Insurance Regulations (Regeling zorgverzekering);
• medicines that are still being clinically tested and that will be made available for distressing cases;
• medicines administered to you when hospitalised or for medical specialist treatment. In that case, those medicines form part of that care

Preference policy

For a number of groups of mutually replaceable medicines, we have allocated a preferred medicine. If you are entitled to a preferred medicine, you are not entitled to another medicine, unless you have a 'medical need' or a 'logistical need'.

Medical need

You have a medical need when it would be medically irresponsible for you to use the preferred medicine. Your prescriber may only note 'medical need' on the prescription if he can substantiate that need. The chemist will check the existence of a medical need. In the event of doubt, the chemist and the prescriber will decide together on the medical need.

In the event of a medical necessity, you will not receive the preferred medicine. In that case, your chemist will choose another medicine with the lowest price on the basis of the prescribed active ingredient and the explanation of the prescriber. Before you receive the medicine of your choice, you must have tried at least two cheaper medicines with the same active ingredient. However, these medicines do need to be available and medically acceptable to you.

Logistical need

You have a logistical need if the preferred medicine is not available in the Netherlands for a prolonged period of time and no other preferred medicine has been allocated.

If you have a logistical need, your chemist will decide which other medicine he will dispense, on the basis of the active ingredient and associated explanation prescribed by the prescriber.

The list of preferred medicines forms a part of the Pharmacy Regulations. We may change the list of preferred medicines at any time. Changes are announced on the page about the preference policy, where you can also read more about the preference policy itself.

In the case of other medicines that we have allocated and that do not appear on the list of preferred medicines, you are entitled to the medicine according to the so-called Lowest Price Guarantee policy. The Pharmacy Regulations explain which conditions apply to that policy. If your prescriber, by noting ‘medical need’ on the prescription, indicates that the medicine allocated under that policy is not medically advisable, the chemist will check the existence of a medical need. In the event of doubt, the chemist and the prescriber will decide together on the medical need. If the prescriber and the chemist are unable to reach an agreement, the position of the chemist takes precedence, unless we decide otherwise. If you are entitled to another registered medicine, your chemist will decide which other medicine he will dispense, on the basis of the active ingredient and associated explanation prescribed by the prescriber.

• the following non-registered medicines in case of rational pharmacotherapy:
  
  • chemist's preparations, unless in the event of:
    
    • chemist's preparations that are (virtually) equivalent to a registered medicine not included in appendix 1 of the Healthcare Insurance Regulations (Regeling zorgverzekering), with the exception of chemist's preparations that;
    • are (virtually) equal to registered UR medicines with regard to which no decision has been made about the qualification within the meaning of Article 2.8.1.a of the Health Insurance Decree (Besluit zorgverzekering), according to Appendices 1 and 3 to this regulation;
    • are (virtually) equal to a registered UR medicine that is listed in Appendix 3, section A of the Healthcare Insurance Regulations (Regeling zorgverzekering), provided the criteria given are met;
• medicines which, following prior consent of the Public Health Supervisory Service and in accordance with rules to be stipulated ministerial regulation, are delivered following an order placed at the initiative of a doctor and which are intended for your use under his supervision, if:
  
  • these medicines have been prepared in the Netherlands by a manufacturer with a licence for preparing medicines pursuant to the Medicines Act (Geneesmiddelenwet), and prepared in accordance with the specifications of that doctor; or
  • these medicines are sold in another EU country or in a third country, and are imported into Dutch territory, if you suffer from an illness suffered by no more than 1 in 150,000 inhabitants in the Netherlands;
  • these medicines are sold in another EU country or in a third country and are imported into Dutch territory as a replacement medicine on account of a shortage of medicines;
• medicines for which the Board has granted a trade licence for the assessment of medicines for public health reasons, if those medicines are not sold in the Netherlands but are sold in another EU country as a replacement medicine on account of a shortage of medicines.
• the following dietary preparations:
  
  • dietary preparations as referred to in appendix 2 of the Healthcare Insurance Regulations (Regeling zorgverzekering). You are only entitled to the dietary preparations referred to in appendix 2 of the Healthcare Insurance Regulations (Regeling zorgverzekering) if the relevant conditions contained in appendix 2 of the Healthcare Insurance Regulations (Regeling zorgverzekering) have been met.
• the following over-the-counter medicines and gastric acid inhibitors:
  
  • laxatives, calcium tablets, medicines for allergies, medicines for diarrhoea, medicines to empty the stomach and artificial tears as referred to in Appendix 2 of the Healthcare Insurance Regulations (Regeling zorgverzekering). You are only entitled to these over-the-counter medicines if the relevant conditions contained in appendix 2 of the Healthcare Insurance Regulations (Regeling zorgverzekering) have been met.
  • gastric acid inhibitors as referred to in appendix 2 of the Healthcare Insurance Regulations (Regeling zorgverzekering). You are only entitled to these gastric acid inhibitors if the relevant conditions contained in appendix 2 of the Healthcare Insurance Regulations (Regeling zorgverzekering) have been met.

You need a prescription

A physician (which also includes a GP, a medical specialist, a doctor for the mentally disabled, a sports doctor, a specialist geriatrics doctor, a nursing specialist and A&E doctor), an orthodontist, a dentist, an obstetrician and a physician assistant may issue a prescription for most medicines. This is subject to the condition that the prescribed medicine is related to the care that the prescribing party generally provides.

Reimbursement for medicines

Under the HollandZorg public healthcare insurance you qualify for the reimbursement of certain medicines (determined by the government). You can see which medicines these are in our conditions. A separate scheme applies to the reimbursement of the statutory personal contribution for contraceptives.