what’s wrong with drugs?

Innogenerics, the last pill factory that produces exclusively for the Dutch market, will stop after this weekend. It underlines that the Netherlands is highly dependent on foreign countries for medicines. And that is not without risks. What is going on?

After the closure of Innogenerics, the Netherlands still has twenty drug factories, three of which are still in Dutch hands. Decades ago there were dozens.

According to the Royal Dutch Pharmacy Association (KNMP), drug users will not immediately notice the closing of Innogenerics.

“But”, says KNMP chairman Aris Prins, “we see shortages in the Netherlands increasing. We would like more to focus on production closer to home, but we see a trend in the other direction. Pharmacists and doctors are more often and longer looking for alternatives, because not all medicines are so easy to obtain.”

Minister of Health Kuipers finds it worrying: “We are increasingly confronted with shortages, also in Europe and the rest of the world. People sometimes notice that they receive medicines in a different box, have to switch more often, or that a medicine is temporarily unavailable. it.”

If a pharmaceutical company wants to bring a medicine onto the market, it is important to end up on the purchasing list of at least one of the big four health insurers – Achmea, CZ, VGZ and Menzis. Together they control almost 90 percent of the market. “If you don’t enter any of the four, you have no chance,” says Hans Waals, director of the Tiofarma medicine factory.

The Netherlands is in the top 3 of European countries with the cheapest generic medicines. “Of course that seems very nice, our politicians are also very proud of it, but it has unpleasant consequences,” says chairman Jean Hermans of Bogin, the trade association of manufacturers of generic medicines.

He calls it one race to the bottom. “What you have seen over the past five years is that if one of the major health insurers does not put a drug on the customer list – and health insurers naturally want the cheapest – that leads to a manufacturer being unable to deliver and stopping production. Then it won’t be profitable.”

According to Bogin’s figures, 3300 of the 8000 generic medicines have disappeared from the Dutch market in five years. The Netherlands is therefore becoming more dependent on countries such as China, India and Spain.

That is why manufacturer Waals now sells more than half of its medicines to countries such as Great Britain, Germany and the US: “There is nothing to earn from producing generic medicines for the Dutch market. There are enough medicines that are sold for 34 cents. sold per box, while the packaging in the Netherlands alone costs 33 cents per box.”

“It’s an upside-down world, isn’t it?” says Hermans, “We get pills from India and sell ours to the US.”

There are even more vulnerabilities in the system: for example, there are 37 medicines that are purchased from one manufacturer by the four major insurers.

“If something goes wrong with that manufacturer or a boat blocks the Suez Canal, many patients are suddenly without medicines,” says Hermans. “We sometimes run out of alternatives because factories here have stopped producing that drug because they no longer had buyers.”

One of the solutions is to build up larger stocks January 1st made a start. “That can help for now, but it is symptom relief. It should be so that it is attractive enough for the market to be able to supply enough,” says Waals.

When asked whether health insurers are also concerned about the fragility of the system and the role they play in keeping medicines cheap, they refer to a earlier statement.

Zilveren Kruis (part of Achmea) says that, like other health insurers, it is making more agreements with European manufacturers.

Kuipers wants to talk to the KNMP and the health insurers about the low prices and the health insurers that all purchase from one manufacturer. “What I find most important is the security of supply for the patient.”