Transcript No Slide Title - AcademyHealth

Striving for openness and
transparency: The
Netherlands’s Drug
Reimbursement System
(GVS)
Tanisha Carino, Ph.D.
AcademyHealth Annual
Research Conference
June 6, 2004
The Intersection of business
Strategy and public policyThe Health Strategies Consultancy
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Acknowledgements
• The Netherlands-U.S. Fulbright Program
• Department of Health Policy and
Management and Institute for Medical
Technology Assessment at Erasmus
University
• The Dutch Ministry of Health, Healthcare
Insurance Board, Health Council, Merck
(DSM), and Novartis.
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Transparency: A Multi-faceted Concept
• Explicit criteria
• Openness of decision-making
• Understandability and publicly available
rationale of final conclusions
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Advantages of an open
transparent process
• Wide-acceptance of final determinations
• Information on patient’s experiences
(compliance and expectations)
• Information on clinical management from
medical professionals
• Information from principal investigators of the
nuances of the evidence being considered
• Strengthening future submissions by
requestors
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What is the GVS?
• System of judging which outpatient drugs
should be paid for by the public insurance
scheme
• Goal of containing costs and promoting prudent
purchasing of outpatient drugs without
restricting choice
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The Importance of the GVS System
• In the NL, no other type of health technology,
undergoes a systematic review for
effectiveness and acceptability prior to
reimbursement
• The GVS will provide the foundation in the
development of future of coverage systems
being considered for in-patient services.
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A response to rising costs
• Annual rise in drug expenditure from 1987 to
1990 where annual growth of pharmaceutical
spending exceeded 8%.
• To combat this in 1991, the government
introduced the GVS reference pricing system.
• 1999 introduction of pharmacoeconomic
guidelines.
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GVS basics
Reference price system introduced in 1991 to limiting
public reimbursement without restricting choice.
– Drugs with comparable therapeutic benefit are
clustered and reimbursed with a single price per
cluster. (List 1a)
– If no clusters is appropriate, drug is reimbursed at the
premium price. As of 2005, cost data will be required
(List 1b)
– Drugs can also be reimbursed with conditions (List 2)
Patients pay the difference between price and
reimbursement limit
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Where does the GVS succeed?:
Explicit Criteria
• The 1999 guidelines give explicit instruction on
who can conduct the research, analytical
techniques, and cost inputs.
• Stakeholder were given opportunity to comment
on guidelines at public meetings.
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An Opaque Process
• Limited input into the development of guidelines
by industry or patient stakeholders.
• Assessment of evidence closed to all outside
stakeholders
• No system for appeal of the process
• Limited public record of meetings, rationale of
decisions, and final recommendations and
decisions.
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Why in Holland?
• Limited influence of the drug and device industry in
the Netherlands
• Lack of coordinated patient advocacy groups
• Small market position of the Netherlands
• This system has only been adopted at this point for
the evaluation of drugs.
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