Heleen de Wit, internist-endocrinologist at the Jansdal Hospital in Lelystad, is strongly against the switch. Together with another internist, she started a petition to call on the health insurer not to switch. The petition has now been signed more than a thousand times.
Health insurer CZ stopped reimbursing the Lantus brand in 2019. Instead, it was going to reimburse Abasaglar. Both medications contain the same active ingredient: insulin glargine. But the composition of the drug differs slightly. Now CZ is designating Lantus again, the medicine they stopped taking earlier, as the medicine that they will reimburse.
According to De Wit, some of all diabetes patients can become quite disrupted by the change. “Think of nausea, headache, fatigue, drowsiness or even becoming unconscious.” Other internists who spoke to RTL News also confirm this picture.
In addition, according to De Wit, it also causes a lot of stress for patients. “If you have type 1 diabetes, you are completely dependent on insulin. It is very easy for the health insurer to say: why don’t you switch? That is not always easy.”
Insecurity
The Diabetes Association also confirms that the transfer can lead to stress in patients. “It creates uncertainty and discomfort. You wonder how something like this works, whether it works just as well, whether you get side effects and more of that.”
“Even though money is saved on the insulin itself, the fluctuating blood sugar values mean that healthcare providers have to adjust those values in patients,” says De Wit. “That means extra checks and therefore an increase in healthcare costs.”
Severe side effects
One of the diabetes patients who can talk about side effects is 36-year-old Danny. He tells RTL News how he suffered from severe side effects when he was given a different drug in 2019. “I started sweating, headaches and fluctuating insulin levels.”
“I suddenly got Abasaglar instead of Lantus, which I normally got,” says Danny. According to the pharmacy it was exactly the same. Still, I got those side effects. My internist sent a letter to my health insurance that I really couldn’t function in this way. After I had walked around with these complaints for three weeks, they finally converted me back to my old medicine.”
What exactly?
Diabetes is a disease in which you have too much glucose (sugar) in your blood. That is unhealthy and can cause health problems. Because the body of people with diabetes does not produce enough insulin itself. Insulin regulates blood sugar levels.
Lantus and Abasaglar are both medicines with the active ingredient ‘insulin glargine’. They are long-acting insulins that work for about 24 hours and are injected through a pen or syringe. Lantus is the original drug. Because Lantus’ patent has expired, another company has counterfeited the insulin. This is the drug Abasaglar.
Health insurers regularly switch to a different brand of medicine to keep costs as low as possible. This is called the so-called preference policy. In our healthcare system, it is also the task of health insurers to keep the costs of medicines low.
According to CZ spokesman Rik van Druten, it is true that policyholders must switch from March. “The price of the drug is the only reason we are switching. I cannot say exactly how much the price difference is. The contract with the supplier is about to expire and it is also in the interest of our policyholders that the premiums remain as low as possible .”
“CZ also sees that if you change something, patients and healthcare providers sometimes don’t like it,” says Van Druten. “We try to take that into account. For example, there are medicines for which it has been agreed that switching is irresponsible. But insulin glargine is not one of them.”
Dates
CZ acknowledges that agreements have also been made by health insurers, patient organisations, doctors and pharmacists about switching medicines. “For example, you can change a maximum of once every two years. We are now doing it within four years, so that is allowed. And we do it because we believe that at the bottom of the line it yields more than it costs.”
CZ also indicates online that ‘if the use of Lantus for people unexpectedly turns out to be medically irresponsible’, another variant of the drug will be looked at.
However, according to internist Heleen de Wit, that is not enough. “The patient is still obliged to try the other insulin first and the pharmacy may also only dispense that drug. If it does not, for whatever reason, the pharmacy will be reduced in the reimbursement that the health insurer gives.”
Regulatory pressure
Pharmacies and other healthcare professionals are faced with a lot of regulatory pressure, says not only De Wit but also the Diabetes Association. “That time could be much better spent.”
“Ultimately, they are also the people who get patients who are angry or do not understand the transfer,” says De Wit. According to her, it will not become cheaper, but more expensive. “All in all, it actually results in a lot of costs for healthcare.”