OBJECTIVES: In Netherlands, new outpatient medicines are reimbursed by the Minister of Health, Welfare and Sport, based on advice from the Zorginstituut (who evaluate their clinical and economic value). By contrast, inpatient medicines (including high-cost biologic drugs administered in an outpatient setting) were reimbursed automatically after European marketing authorization, regardless of the cost. This changed in July 2015, when a sluis/‘lock’ system was introduced for certain inpatient medicines (with high budget impact) which are not reimbursed, pending financial negotiations. This research evaluates all therapies included in the reimbursement ‘lock’ system.

METHODS: Websites for the Netherlands’ government (https://www.rijksoverheid.nl/), Zorginstituut (https://www.zorginstituutnederland.nl/), and official government publications (https://www.overheid.nl/) were screened for any drugs added to the reimbursement ‘lock’ system and key data extracted (01/JAN/2015-29/JUN/2020).

RESULTS: 36 drug indication pairings have been added to the reimbursement ‘lock’ system (1 in 2015, 3 [2016], 7 [2017], 11 [2018], 10 [2019], and 4 [2020]). 78% (28/36) were for oncology indications [notably 25% (9/36) were immune-oncology [8 anti-PD-1/L1 and 1 anti-CTLA-4] therapies] and 50% (18/36) were for orphan indications. 58% (21/36) had been removed from the lock after an average of 11.1 months (range: 1.2-21.7), with the 42% of therapies remaining having been there for a mean of 12.4 months (range: 1.7-34.7). The price discounts/savings negotiated for each drug under the ‘lock’ is not publicly disclosed. However, the first drug to enter the ‘lock’ was nivolumab for lung cancer, whose projected annual cost was €200 million, which represented approximately an eighth of the Netherlands' total inpatient pharmaceutical expenditure.

CONCLUSIONS: The reimbursement ‘lock’ is being increasingly utilized as a cost-containment mechanism for inpatient drugs in the Netherlands. This has been primarily applied to oncology medications, particularly immuno-oncology therapies. Though this may have driven significant cost savings for the public payer, it has also delayed patient access by an average of 11.7+ months.