Medicinal care

Reimbursement for medicines

With your HollandZorg basic health insurance, you qualify for the reimbursement of certain medicines (determined by the government). Separate coverage applies to contraceptives.

You are entitled to medicinal care. Medicinal care (pharmaceutical care) consists of the dispensing (by the chemist) of the medicines and dietary preparations listed below. Medicinal care also includes the advice and support which dispensing chemists generally provide for the medication assessment and responsible use of prescribed medicines.

You are entitled to the following medicines and dietary preparations:

1. the following registered medicines contained in Appendices 1 and 2 of the Healthcare Insurance Regulations (Regeling zorgverzekering):
   
   
   1. the preferred medicines on the list of preferred medicines. You can view the up-to-date list of preferred medicines at www.hollandzorg.com/conditions. We may change the list of preferred medicines on a monthly basis. We can also send you the list on request.
      
      We refer to the allocation of preferred medicine as 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 in the event of a 'medical need' or a 'logistical need' (more about this in points c and d below).
      
      
      
   2. the mutually replaceable medicines from the groups of interchangeable medicines in which no preferred medicine has been allocated. If there is a choice between several interchangeable medicines within a group, you are entitled to:
      • the cheapest medicine within that group. The cheapest medicine is the medicine with the lowest pharmacy purchase price (AIP) according to the G-Standard of Z-Index B.V. You can request the cheapest medicine and its price via the contact form on our website www.hollandzorg.com/conditions or by calling +31 (0)570 687 123. Alternatively, ask your chemist;
      • the medicine that is a maximum of 3% more expensive than the cheapest medicine in that group.

    

   This does not applyin the event of a 'medical necessity' or a 'logistical necessity' (more about this in points c and d below).

   c. In derogation from a and b above, you are entitled to the prescribed medicine in the event of a medical necessity ('MN'). This does not apply in the event of a 'logistical necessity' (more about this in point d below)A medical need is deemed to exist when it would be medically irresponsible for you to use the preferred medicine or the medicine chosen by the chemist. Your prescriber may only note 'medical need' on the prescription if he can substantiate that need. The chemist assesses the effective existence of a medical need. If in doubt, the chemist will contact the prescriber for consultation and coordination about the medical need. In the event of a medical necessity, You will not receive the (preferred) medicine. In that case, you are entitled to an alternative medicine that you need on the basis of care-related criteria. The pharmacist and prescriber can discuss this between them.
   
   d. in derogation from a, b and c above, you are entitled to the medicine chosen by the chemist in the event of a logistical necessity ('LN'). 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. In the event of 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.

   1. e. all non-interchangeable medicines.

   
   Appendix 2 of the Healthcare Insurance Regulations (Regeling zorgverzekering) states additional conditions for the provision of the medicines mentioned in those regulations. You are only entitled to those medicines if you meet these conditions.
   
   

2. the following non-registered medicines in case of rational pharmacotherapy:
   
   
   1. chemist's preparations, unless they are 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 (prescription medicines only) with regard to which no decision has been made about the qualification within the meaning of Article 2.8, paragraph 1, subparagraph 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;
   2. medicines which, following prior consent of the Health and Youth Care Inspectorate (Inspectie gezondheidszorg en jeugd) 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;
   3. medicines for which a marketing authorisation has been granted by the Medicines Evaluation Board (MEB) for public health reasons, as a replacement medicine due to a shortage of medicines. The condition is that those medicines are not available in the Netherlands, but are in another EU country.

    

3. the 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.
   
   
   
4. the following over-the-counter medicines and gastric acid inhibitors:
   1. 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.
   2. 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.
      

Medicinal care does not include:

• medicines to prevent travel sickness;
• medicines for research (medicines as defined in article 40, paragraph 3, subparagraph b of the Medicines Act (Geneesmiddelenwet));
• medicines that are (virtually) equivalent to a registered medicine not included in appendix 1 of the Healthcare Insurance Regulations (Regeling zorgverzekering);
• medicines that are still being used for clinical testing and which are made available for distressing cases (medicines as defined in article 40, paragraph 3, subparagraph b of the Medicines Act (Geneesmiddelenwet));
• medicines you receive within the framework of an admission or medical specialist treatment, provided they form (or are supposed to form) part of that admission or treatment. In that case, those medicines form part of that care.

The contents of Appendices 1 and 2 of the Healthcare Insurance Regulations may change from time to time. You can view and download the current content at www.hollandzorg.com/conditions.

How long do we reimburse medicines?

We do not issue medicines in unlimited quantities. Per dispensing (by the chemist), you are entitled to medicines for a period of:

- a maximum of 12 months, if it concerns the contraceptive pill (oral contraceptives).

- a minimum of 3 and a maximum of 12 months, if you have a chronic condition and you have been using the medicine for at least 6 months and you have properly adjusted to that medicine. In derogation from this, the dispensing of benzodiazepines, hypnotic drugs and anxiolytic drugs is subject to a maximum period of 1 month. The prescriber determines whether it concerns a chronic condition.

- a maximum of 1 course or 1 month, in the case of antibiotics or chemotherapy to combat acute conditions.

- a maximum of 15 days or the smallest supply packaging for a medicine that is new to you

- a maximum of 1 month in all other cases.

What do I need to keep in mind?

- Dispensing chemists and dispensing general practitioners can provide this type of care.

- Dietary preparations may also be supplied by suppliers of dietary preparations.

- 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 or an 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.

- The following applies to the medicines contained in Appendix 2 of the Healthcare Insurance Regulations (Regeling zorgverzekering):

• for polymer, oligomer, monomer and modular dietary preparations, the first prescription for each indication may only be issued by a dietician, youth healthcare doctor, general practitioner or medical specialist.
• for a hepatitis vaccine, diphtheria vaccine, poliomyelitis vaccine, whooping cough vaccine or combinations of two or more of these vaccines or with the tetanus vaccine, the first prescription for each indication may only be issued by a general practitioner or medical specialist.
• for a pneumococcal vaccine, the first prescription for each indication may only be issued by a medical specialist.
• for the other medicines listed in Appendix 2 of the Healthcare Insurance Regulations, the first prescription for each indication may only be issued by a medical specialist with demonstrable specific expertise in the treatment of the indication for the medicine in question listed in Appendix 2 of the Healthcare Insurance Regulations. Is a doctor's note from Zorgverzekeraars Nederland available for the medicine? And does that doctor's note not only mention medical specialists as prescribers, but also other care providers? For example, a general practitioner? The first prescription per indication may then also be issued by the other care provider(s) mentioned in the doctor's note.
• a medicine may be prescribed by a prescriber other than the prescriber named for the medicine if you suffer from a very rare condition with a non-registered indication for the supply of that medicine and that prescriber is specialised in the treatment of that condition. In that case, the supply of the medicine is subject to our written authorisation.

Consent

In order for you to be entitled to these medicines contained in Appendix 2 of the Healthcare Insurance Regulations (Regeling zorgverzekering), you must have received our written authorisation before receiving the care.

• infant formula in the event of cow's milk allergy without a challenge test being performed;
• infant formula in the event of cow's milk allergy for children aged 2 years and older;
• infant formula in the event of cow's milk allergy in quantities of more than 1000 ml per day;
• epoprostenol intravenous;
• iloprost for inhalation;
• treprostinil subcutaneously and intravenously;
• contraceptives in case of treatment of endometriosis and menorrhagia;
• medicines if you suffer from a very rare condition with a non-registered indication for the supply of those medicines;
• a medicine that has been added to Appendix 2 of the Healthcare Insurance Regulations during the calendar year. This does not apply if the procedure of a doctor's note and dispensing chemist's instruction exists for that medicine. In that case, that procedure can be followed.

You must enclose a copy of the prescription with your request.

Doctor's note and dispensing chemist's instruction

The procedure of the doctor's note and dispensing chemist's instruction may apply to the right to other medicines included in Appendix 2 of the Healthcare Insurance Regulations. In that case, the dispensing chemist or dispensing general practitioner must determine the right to the medicine based on a doctor's note or dispensing chemist's instruction. The prescription must then be accompanied by a fully completed, dated and signed doctor's note. The dispensing chemist or dispensing general practitioner must act in accordance with the associated dispensing chemist's instruction and, on that basis, assess whether you are entitled to reimbursement of the costs of the medicine. Visit www.znformulieren.nl to check whether the procedure of the doctor's note and dispensing chemist's instruction applies. The procedure of the doctor's note and dispensing chemist's instruction and their content may change from time to time. Visit www.znformulieren.nl for up-to-date information.

If you object to the procedure of doctor's note and dispensing chemist's instruction, you can also submit a request for authorisation directly to us.

Authorisation for (resold) chemist's preparations

Chemist's preparations are non-registered medicines that are made on a small scale in one pharmacy by or on behalf of a chemist or dispensing general practitioner. Transferred chemist's preparations are chemist's preparations that are transferred to another pharmacy. The reimbursement of certain chemist's preparations, designated by us, is subject to our written authorisation before you receive the care. The chemist's preparations for which authorisation is required are listed in the overview Reimbursement for chemist's preparations. This overview can be viewed and downloaded at www.hollandzorg.com/conditions.

When applying for care you will need to send us a copy of the prescription and a report from the attending physician including the medical diagnosis/diagnoses, a description of the current problem and the proposed treatment plan.

Is there a statutory personal contribution?

Yes, if the medicine is classified into a group of interchangeable medicines and the purchase price is higher than the reimbursement limit. A statutory personal contribution is also due when a medicine is prepared from a medicine for which a statutory personal contribution is due. The Healthcare Insurance Regulations (Regeling zorgverzekering) stipulate how the personal contribution is calculated. In the year 2025, the extent of your statutory personal contribution will be a maximum of €250 per calendar year. If your public healthcare insurance does not commence or end on 1 January of a calendar year, the compulsory contribution for your public healthcare insurance for that calendar year is set lower, in proportion to the number of days insured. The calculated amount is rounded off to whole Euros.

Are the costs deducted from the compulsory excess?

 Yes, from 18 years and older.

No compulsory excess applies to contraceptives and the dispensing thereof as referred to in appendix 2 of the Health Insurance Regulations. Nor does compulsory excess exist for a medication assessment, as included in and under the conditions of the overview 'Designated care not subject to excess'. The up-to-date overview can be viewed and downloaded at www.hollandzorg.com/excess.

No compulsory excess applies to preferred medicines allocated by us as included in and under the conditions of the overview 'Designated care not subject to excess'. The delivery costs, the counselling consultation for a preference medicine and inhaler instructions do fall under the compulsory excess.

Do I have to pay extra for non-contracted care?

Do you wish to use the care from a care provider with whom we have not concluded a contract? In that case, the reimbursement may be less than the amount charged by your care provider. The maximum reimbursements can be found on the rates lists for non-contracted care on our website. Contracted care providers are listed at hollandzorg.z-zoeker.nl/.