13-10-2025
In a case in which Niels van Steijn represented a collective of pharmacists, the District Court of The Hague ruled in favour of the collective in a dispute with health insurer Zilveren Kruis regarding the reimbursement of PCSK-9 inhibitors in combination with ezetimibe in the period 2017-2022.
According to the court, Zilveren Kruis was not allowed to stipulate that PCSK-9 inhibitors are only eligible for reimbursement if ezetimibe is prescribed in a dosage of 10 mg per day.
This requirement is not stipulated by law (Appendix 2). Moreover, it would mean that pharmacists would have to deviate from the doctor's prescription solely in order to obtain reimbursement for PCSK-9 inhibitors. This would prevent patients from receiving the care they need. The doctor is free to deviate from the recommended dosage if there is reason to do so. It is also incompatible with the Health Insurance Act system if medication is prescribed with the advice not to use it or to throw it away, solely to comply with the conditions in Appendix 2. This is not effective and leads to a waste of medication. Pharmacists are legally and contractually obliged to provide safe, effective, efficient and client-oriented care that is tailored to the actual needs of the insured person. In the opinion of the court, the requirement imposed by Zilveren Kruis on the dosage of ezetimibe is not compatible with the legal and contractual principle of appropriate use and efficiency.
The court ruled that Zilveren Kruis was not entitled to stipulate a dosage of 10 mg of ezetimibe per day, nor was it entitled to impose any other conditions on the dosage and/or frequency of ezetimibe. In addition, Zilveren Kruis must cease the recovery and repay the amounts already paid by the pharmacies concerned, totalling €90,925.62, to the NFZ collective (plus statutory interest).
Click here for the verdict [https://uitspraken.rechtspraak.nl/details?id=ECLI:NL:RBDHA:2025:18738].
If you have questions please contact Niels van Steijn.
