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NMa Permits Preference Policy for Health Insurers

Five Dutch health insurers, CZ, VGZ, Agis, Menzis and Univé, may designate different suppliers for three groups of medicines from 1 July 2005 onwards, whose medicines they wish to reimburse for a period of six months. The so-called 'preferred' suppliers are selected on the basis of the price which they ask for their medicines. As a result, most medicines, whose price proves to be too high, will no longer be reimbursed, unless there is a medical indication for these medicines. NMa has allowed the health insurers' joint preference policy because the joint policy is necessary to give the suppliers with an incentive to compete on the basis of price, as a result of which the lowest possible final price will be determined, according to NMa in an informal opinion.

To manage the cost of medicines, the government has given health insurers the possibility of conducting a preference policy. Since this involves an agreement between companies which are each other's competitors, NMa tested the preferencel policy of the five health insurers on the basis of competition law. It is important for NMa that sufficient competition remains between health insurers. According to NMa, there will be sufficient competitive pressure because not all health insurers participate in the policy. In addition, (for the time being) the policy applies to a limited number of medicines. In addition, the procedure offers all suppliers the possibility of qualifying for 'preferential' status, which only applies for a period of six months. In addition, health insurers have indicated that they will settle the savings through the premiums, as a result of which their policyholders will benefit. As of 1 January 2006, two other health insurers will join the preference policy (De Friesland Zorgverzekeraar and Delta Lloyd/Ohra). This has already been taken into account in the assessment under competition law.

The policy presented to NMa applies to three groups of medicines: omeprazol (a proton pump inhibitor), simvastatine and pravastatine (lipid regulators). A medicine is preferred if the supplier offers the lowest price or if the supplier's price is within a bandwidth of 5% of the lowest price. As a result, numerous suppliers may be preferred for the same medicine. Policyholders are reimbursed for the cost of these medicines.

NMa draws the health insurers' attention to the fact that in the autumn of 2006, and if market conditions change in the future, the preference policy will have to be reviewed to ensure that it complies with the criteria of competition law. This applies, for instance, in the event of an increase in the number of insurers participating in the preference policy or an increase in the number of medicines to which the preference policy applies.

An informal opinion is issued to market parties to provide clarity on a certain legal problem. An informal opinion is not a formal decision and is drawn up at the request of the parties and on the basis of information provided by these parties. NMa does so, for instance, when an innovation occurs or if the public interest is affected sufficiently.