The Dutch sluis is a temporary exclusion mechanism for selected high-cost hospital medicines, under which a medicine is kept outside the basic health-insurance package while the authorities assess reimbursement and negotiate financial conditions. Two recent decisions show the mechanism operating in two different ways - either to prevent entry after failed price talks or to continue access where renewed financial arrangements were judged sufficient.
On 20 May, the Minister of Health, Welfare and Sport (Ministerie van Volksgezondheid, Welzijn en Sport, VWS), Sophie Hermans, informed Parliament that Tecvayli and Talvey would continue to be covered by the sluis. In practical terms, both medicines remain excluded from the basic package and are not reimbursed under statutory health insurance.
The decision followed positive reimbursement advice from the National Health Care Institute (Zorginstituut Nederland, ZIN), but that advice was conditional on successful price negotiations. For Tecvayli, ZIN advised reimbursement only if the net price were reduced by at least 40% to 60%, depending on assumptions about the confidential price of the comparator. For Talvey, ZIN advised reimbursement only if inclusion did not create additional costs compared with Tecvayli.
VWS did not reach acceptable terms with the supplier after confidential negotiations. The medicines therefore remain outside the basic package for the time being. The letter also notes that Elrexfio, described by VWS as a therapeutically equivalent alternative for the same patient group, entered the basic package on 10 December 2025.
A ministerial regulation published on 27 May showed the other side of the same mechanism. VWS extended temporary basic-package inclusion for evinacumab until 1 January 2031 and atidarsagene autotemcel until 1 January 2032. The extensions follow renewed financial arrangements with the suppliers, which VWS considered sufficient to manage the financial risks of use.
The decisions show the sluis operating as a managed holding mechanism for selected high-cost hospital medicines. Positive advice from ZIN can support reimbursement, but it does not by itself secure access under the basic package. The final position depends on whether the authorities judge the medicine’s expected health gain, price, budget impact and financial-risk controls acceptable for the healthcare system.
Source: Ministry of Health, Welfare and Sport
Link: Brief van de minister van Volksgezondheid, Welzijn en Sport (Letter from the Minister of Health, Welfare and Sport)
Link: Regeling van de Minister van Volksgezondheid, Welzijn en Sport van 19 mei 2026, kenmerk 4380784-1098098-GMT houdende wijziging van de Regeling zorgverzekering in verband met verlenging van de tijdelijke opname van de geneesmiddelen atidarsagene autotemcel en evinacumab in het basispakket (Regulation of the Minister of Health, Welfare and Sport of 19 May 2026 amending the Health Insurance Regulation in connection with the extension of the temporary inclusion of atidarsagene autotemcel and evinacumab in the basic package)
Date: 20 May 2026 and 27 May 2026
