Sometimes policyholders receive a different medicine from their pharmacy than they are used to. That medicine then has the same active ingredient, but is from a different manufacturer and looks different. This is usually due to the preference policy of the health insurer. The Health Insurance Disputes Committee has clarified the preference policy in recent rulings. This is reported by the Stichting Klachten en Geschillen Zorgverzekeringen (SKGZ).
The basic rule is: an insured person is entitled to registered mutually replaceable medicines designated by the minister. The legally defined preference policy is the only permitted restriction on this.
Clarification of implementation of statutory preference policy
A health insurer can designate one or more medicines with a specific active ingredient as a preference. The following matters are important in this regard:
- Is the use of a preferred medicine not medically justified for the insured person? Then it is up to the prescriber (eg the GP) to explain the ‘medical necessity’.
- Is the pharmacist in doubt about the explanation given? The latter must then contact the prescriber.
- If they cannot reach an agreement together, the pharmacist must substantiate on the basis of his professional knowledge why the treatment with the preferred medicine is medically justified for the insured person.
- The Guide to Responsible Switching of Medicines can be used for this.
Information obligation by health insurer
Does a health insurer have a preference policy? In that case, these insured parties must inform them in good time via the policy conditions and the website.
By: National Care Guide