The Dutch government has published its 2025 progress report on financial arrangements for expensive medicines, giving an annual account of how confidential agreements and the sluis are being used to manage access to high-cost products. The sluis is the Dutch mechanism under which selected high-cost hospital medicines are temporarily kept outside the basic health insurance package while the National Health Care Institute assesses their value and the government negotiates financial conditions for reimbursement.
Minister of Health, Welfare and Sport Fleur Agema sent the letter Voortgang financiële arrangementen geneesmiddelen 2025 (Progress on financial arrangements for medicines 2025) to the House of Representatives on 29 June. The report covers medicines where inclusion in the basic health insurance package depends on financial conditions agreed with the supplier.
The number of medicines with financial arrangements rose from 56 to 58 in 2024. Realised expenditure before reductions reached about €1.795 billion, compared with €1.714 billion in 2023. Total expenditure reductions reached about €1.098 billion, including €432 million from public price reductions and €665.4 million from confidential rebates. Expenditure after the arrangements was about €1.129 billion.
The report is also explicit about residual uncertainty. Where the National Health Care Institute (Zorginstituut Nederland, ZIN) gave a concrete discount recommendation, the government assessed whether the negotiated result fell within that range. For medicines where the recommended discount was not fully achieved, €74.3 million of 2024 expenditure carried a higher risk of non-cost-effective use.
The access signal is clearest in the sluis. Hemgenix, Xenpozyme, Enhertu, Carvykti and Pluvicto remained outside the insured package for relevant indications after negotiations failed to produce what the government considered a socially acceptable price. The government said it would reconsider continuation of the sluis if suppliers agreed acceptable arrangements.
Timelines are improving but remain long. For inpatient medicines with financial arrangements, the average time from European marketing authorisation to package inclusion fell to about 19 months in 2025. At the start of 2026, however, 71 inpatient medicines in the sluis still had no complete dossier submitted to ZIN.
The Dutch report therefore shows a mature confidential-pricing system under continuing pressure. Financial arrangements reduce expenditure and can support coverage, but access remains dependent on evidence readiness, timely filing and a negotiated net price that the government considers proportionate to expected health gain.
Source: Ministry of Health, Welfare and Sport
Link: Voortgang financiële arrangementen geneesmiddelen 2025 (Progress on financial arrangements for medicines 2025)
Date: 29 June 2026
