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Add-on medicines

Certain types of medicines are very costly. These are referred to as ‘add-on medicines’ or ‘expensive medicines’. Examples include certain cancer treatments or medications for rare diseases. A well-known example of a medicine that is not classified as an add-on is paracetamol. Although add-on medicines represent only a small portion of all medications, their spending in the Netherlands alone reached €2.7 billion in 2024. Plus, these costs have risen significantly over the past few years, increasing by as much as 100 million over a four-year period.

Reimbursement

Add-on medicines are billed separately and therefore listed individually on the hospital invoice. Other medicines fall under the care package of the treating specialist (DBC) and are not itemised on the invoice.

Whether an add-on medicine is reimbursed depends on several factors, including:

  • the medicine itself;
  • the condition for which it is prescribed;
  • and the terms of your health insurance policy.

Reimbursement may therefore vary from patient to patient. Would you like to know whether a specific medicine is covered by your insurance? If so, please contact your health insurer. They are best placed to inform you about the options available under your policy.

Clinical Studies

Patients may sometimes receive a new add-on medicine as part of a clinical study. Clinical studies investigate the effectiveness and safety of new medicines. These studies are subject to strict laws and regulations.

If there are opportunities to participate in a clinical study, the doctor will provide the patient with detailed information. Participation in a clinical study is always voluntary.

Visit this page for an overview of the clinical studies (only available in dutch) at Erasmus MC.

Societal Role of Erasmus MC

The healthcare system in the Netherlands is increasingly under pressure. People are living longer, and the number of treatment options continues to grow. As a result, there is a shortage of sufficient healthcare professionals. At the same time, the costs of medicines are rising, and the environmental impact of healthcare is becoming more significant.

Action is needed to ensure that healthcare in the Netherlands remains accessible and of high quality for everyone, while also reducing its environmental footprint. That is why Erasmus MC places great emphasis on the more cost-efficient use of add-on medicines.

For example, in the case of cancer treatments, we collaborate with other hospitals to use these medicines as effectively as possible. We aim to administer them at the lowest effective dose and for the shortest possible duration—maintaining efficacy while reducing side effects and the number of hospital visits. We also redistribute unused medicines, including both infusions and oral medications.

In addition, extensive research is being conducted into the more cost-efficient use of add-on medicines in other specialties, such as Gastroenterology, Pulmonology, and Immunology.

Through collaboration between various departments and hospitals, we all contribute to keeping healthcare accessible.

Add-on medicines groups

Oncolytics

Oncolytics are medicines used to treat cancer. Newly developed oncolytics can be particularly expensive. An example of a costly oncolytic is targeted therapy.

What is targeted therapy?

Targeted therapy acts on specific characteristics of cancer cells, for example by blocking a distinct type of protein found in the cancer cell. Because targeted therapies are specifically aimed at tumor tissue, there is less damage to healthy tissue. As a result, targeted therapy generally causes fewer side effects than chemotherapy.

Stem Cell Transplantation

Certain types of cancer, such as acute leukemia and lymphoma, can be treated with a stem cell transplantation. During the transplant, a patient receives stem cells. These stem cells may come from the patient themselves (autologous stem cell transplant (only available in dutch)) or from a donor (allogeneic stem cell transplant (only available in dutch)).

CAR-T Cell Therapy

In recent years, certain types of cancer can be treated with CAR T-cell therapy. In this therapy, the patient’s immune cells are modified to attack and eliminate cancer cells.

How does CAR-T cell therapy work?

In CAR-T cell therapy, white blood cells are collected from the patient. These white blood cells are part of the body’s immune system. After collection, the cells are modified in a laboratory by inserting a specific gene. This gene enables the white blood cells to recognize, attack, and eliminate cancer cells. The modified white blood cells are then administered back to the patient.

You can read more about this treatment on the page ‘CAR-T Cell Therapy (only available in dutch)'.

Orphan Drugs for Rare Diseases

Orphan drugs are medicines used to treat rare conditions. In most cases, these are life-threatening conditions that cannot be treated in any other way and primarily affect children.

Examples of diseases treated with orphan drugs include Pompe disease and mucopolysaccharidoses (MPS) (the links are only available in Dutch).

Reimbursement of Orphan Drugs

Medicines are only reimbursed when scientific research has shown that the drug is effective. For orphan drugs, the number of patients with the specific disease is very small, which means the scientific evidence for their effectiveness is often limited.

To encourage research into treatments for very rare diseases, the Orphan Drug Regulation was introduced in Europe in 2000. This policy makes it possible to develop and reimburse medicines for rare and serious conditions. Since 2000, more than 260 drugs have been registered as orphan drugs in Europe.

Coagulation Factors

Patients with bleeding disorders are treated with coagulation factors. These factors are often administered by injection.

Bleeding Disorders

In bleeding disorders, the blood does not clot properly, causing patients to experience more frequent or severe bleeding. This can lead to easy bruising, prolonged bleeding after injury, and in severe cases, bleeding in muscles and joints. While bleeding disorders cannot yet be cured, they can now be effectively managed.

Hemophilia Treatment Center

The Erasmus MC Hemophilia Treatment Centre is one of the largest hemophilia centers in the Netherlands. Here, patients with various bleeding disorders, such as hemophilia and von Willebrand disease, receive treatment.

Read more about Erasmus MC Hemophilia Treatment Centre (only available in Dutch).

Biologicals

Biologicals are medicines produced using biotechnology. This means that human or animal proteins are used in the manufacturing process. Biologicals inhibit the activity of inflammatory proteins or immune cells. These medications are used to treat autoimmune diseases such as rheumatoid arthritis, Crohn’s disease, and psoriasis, and are also effective in treating certain types of cancer.

Biosimilars

Biologicals with the same active substance are called biosimilars. The cost of different biosimilars within the same group can vary, even though their quality and effectiveness are equivalent. In some cases, switching to a more affordable brand is considered. The prescribing physician will always discuss this with the patient first.