The generic‐patent medicine conflict flares up again in The Netherlands

Recently I reported in this journal¹ how it became necessary for a judge to settle a dispute between the pharmaceutical industry and certain Dutch pharmacists. It considered the question of whether a pharmacist is permitted, without prior consultation, to give a patient a (cheaper) generic drug instead of the patent drug mentioned on the prescription.

Another dispute has now arisen after the pharmaceutical industry discovered that healthcare insurers were paying general practitioners (GPs) a bonus if they prescribed generic drugs, such as simvastatin (which reduces cholesterol content) or omeprazol (which reduces the production of gastric acid), instead of the more expensive patent forms (Zocor and Losec, respectively). According to the national newspaper, Trouw,²,³ Menzis, one of the largest healthcare insurers, offered each of 2300 GPs up to €8000 annually if they switched their patients from patent drugs to the equivalent generic forms. Since the offer was made, more than 160 GPs have agreed to comply with this condition. If most GPs follow this example, Menzis hopes to save more than €3 million each year. GP Geert van Loenen and five other doctors,⁴ however, have rejected the offer and are annoyed that their colleagues “have sold themselves in such a way to the insurer”. At the same time four of the leading drug companies; Pfizer, Merck, AstraZeneca and Altana, have taken legal action against Menzis. One of their main arguments was that there existed a code which stated that insurers were not permitted to influence the medical profession on how to treat their patients. On 14 October 2005,⁵ a judge at the law court in Arnhem decided otherwise. He concluded that the competition that exists between insurers since a recent law on health insurance was approved by the Dutch parliament has changed the system. It is in the interest of the insurers to offer their patients the lowest insurance rates. This may entail the payment of a bonus to the GP as long as the patient is not the worse for it. The GP has the right to determine what drug he wishes to prescribe. Furthermore, the code (mentioned above) was not devised for the purpose of protecting the pharmaceutical industry.

According to the newspapers, the Royal Dutch Society of Medicine is surprised at the judicial outcome and a number of patient organisations are disturbed by the judge's decision. The pharmaceutical companies are now considering whether they should take the issue to a court of appeal.

In my opinion, there exists here a difference between a legal and an ethical solution to the conflict. I believe that it is unethical for a physician to accept a bonus from an insurer. I hereby express my admiration for those GPs who have declined to sign the contract with the insurer, Menzis.