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Reimbursement - Netherlands UPDATE

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Reimbursement of Wound Care Medical Devices in the Netherlands – Update on the reforms of 2015/6

BACKGROUND Health care insurance in the Netherlands is mandatory. Every person has to have their own basic health care

insurance (Basisverzekering), except those under 18 who are automatically covered by their parents' contribution.

Insurers have to offer a universal package for everyone over the age of 18 regardless of age or state of health.

On top of the basic health care insurance additional and optional health insurance packages are available.

Reimbursement of wound care products is covered by the basic health care insurance, specifically defined as:

“complex treatment, chronic wounds”. The list of wound care products reimbursed by the Health Insurance

companies is given in the “Z-Index” in alphabetical order with a VB (Verbandmiddel) coding.

Unit reimbursed prices given in the Z-Index are recommended prices only; the actual reimbursement for each

product is negotiated between the insurance companies and the final suppliers who handle the prescription for the

product.

THE FOLLOWING CHANGES HAVE BEEN ANNOUNCED

1. Increase in the patient’s compulsory contribution (€ 385 in 2016) The Dutch law requires everyone to pay a compulsory annual contribution to the basic health care insurance, over

and above their insurance premiums.

For 2016 this will be € 385; an increase of 2.7% over 2015.

The person insured can increase their own contribution voluntarily for 2016 up to a maximum of € 885 to lower their

monthly health insurance premiums.

2. Applications for reimbursement of newly launched wound care devices are again possible Until December 2014, the committee for wound care of The Association of Dutch Health Insurers (ZN: Zorgverzekeraars Nederland) was responsible for evaluating dressings and compression bandages. This committee was then adjourned, after which a vacuum arose regarding the reimbursement of new wound care

products. For six months no new products could be evaluated and therefore could not be registered for

reimbursement. On July 1st 2015 ACHMEA, one of the biggest insurance groups, launched their own new policies for

evaluating new wound care devices and so broke this impasse.

Author: Barry Willemsteijn

Mr Willemsteijn has more than 25 years clinical and business experience in woundcare across Europe. A nurse by profession, the founder and former President of the Dutch Wound Care Association (WCS) he has held Marketing and Sales positions at ConvaTec, Dermagenics Europe and Beese Medical.

Wound Market Consulting Tel: +44 (0) 1869 238040 Cherwell Innovation Centre, Upper Heyford, Bicester Email: enquiries@woundmarketconsulting.com Oxfordshire, OX25 5HD United Kingdom www.woundmarketconsulting.com

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Reimbursement - Netherlands UPDATE3. Restricted reimbursement of products delivered by a non-contracted care supplier A supplier of wound care devices (e.g. pharmacist or medical supplies house) with which a patient’s health insurance company has no contract, is called a non-contracted supplier. If the patient obtains their products from this supplier they will face restrictions on the sums reimbursed. Some companies reimburse only up to 75% of the average of the contracted rate. Most of the health insurance companies will adopt this policy in 2016.

4. Restricted number of deliveries per prescription One of the main health insurance companies (VGZ) has established a maximum number of products and a standard

number per delivery. Other insurance companies will adopt this procedure in 2016. Maximum quantities of product

to be dispensed at any one time have been established for the following categories. The categories with maximum

dispensing quantities are listed below:

Category of medical devices Supplied by Foam dressings Supplied by

Compression bandages Max. 4 pieces Size 7.5x7.5cm Max. 5 pieces

Padding Max. 1 piece Size 8cm up to and including 10x12cm Max. 5 piece

Tubing Max. 1 piece Size 12cm up to and including 15x15cm Max. 5 piece

Adhesive plaster Max. 1 piece

Film dressings Supplied by

Gauzes and compresses Supplied by Size 10cm or smaller Max. 10 pieces

Size 5x5cm up to 7.5cm Max. 100 pieces Size 8cm up to and including 10x12cm Max. 10 piece

Size 7.5x7.5cm up to 10cm Max. 100 piece

Size 10x10cm Max. 100 piece Tubings Supplied by

Size larger than 10x10cm Max. 15 piece Size 7.5cm up to and including 12cm and all lengths

Max. 1 pieces

5. Standardisation of pricing by reference pricing Reimbursement is now based on the price of the lowest priced product in the respective category of products with

comparable features such as Alginates, Foams and Hydrocolloids.

Other insurers will follow the standardisation policy of the main insurers in 2016.

6. Compression Garments with antibacterial elements are no longer reimbursed by the

Health Insurance Act The Dutch Care Institute has determined that there is little scientific evidence to endorse the clinical effectiveness of

these products. As of January 1, 2016 only compression garments without antimicrobial elements will be

reimbursed.

7. Less bureaucracy for the Family Doctor Recently the national association of family doctors (LHV) came to an agreement with health care insurers and

patients on new methods of cooperation for 2016.

Under this agreement significantly fewer forms and licences will be required (e.g. the Application Form for wound

care products indicated for complex/chronic wounds).

A prescription with the statement 'medical necessity' will be sufficient.

CLOSING REMARK The Dutch trade association for Medical Technology (FHI) expects further announcements of changes in early 2016.

No information on these changes has yet been received.

Wound Market Consulting Tel: +44 (0) 1869 238040 Cherwell Innovation Centre, Upper Heyford, Bicester Email: enquiries@woundmarketconsulting.com Oxfordshire, OX25 5HD United Kingdom www.woundmarketconsulting.com

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Reimbursement - Netherlands UPDATENotes:

1. Websites of the 4 major insurance companies in the Netherlands, representing the following market shares: Achmea 32%; VGZ 24%; ( www.vgz.nl) CZ 20%

(www.cz.nl) and Menzis (www.menzis.nl) 13%.

2. ZN = Zorgverzekeraars Nederland. The association of Health Insurers Netherlands represents the interests of all insurers. The association aims to support

insurers in their mission: to achieve quality, affordable and accessible care for all insured persons, aimed at promoting health and quality of life.

3. LHV = Landelijke Huisartsen Vereniging. LHV is the national association of family doctors. Representatives of the LHV are regular interlocutors of Minister of

Health.

4. FHI = Federatie van Technologie Branches. The Dutch trade association for Medical Technology trade brings together about 130 manufacturers and suppliers.

Most wound care companies are members of the FHI.

Contact Wound Market Consulting for help in market entry, identifying reimbursement

opportunities, designing clinical studies to support reimbursement and project

managing studies and applications.

Our network extends across Europe, Canada, United States, Australia and Latin America.