Support for cost-effective prescribing from Dutch Order of Medical Specialists

The Dutch Order of Medical Specialists has launched a campaign to encourage cost-effective prescribing among their physician members. Ensuring the long-term affordability of healthcare was defined as a goal for this program: “Good healthcare is safe, effective, patient-centered, timely, accessible and cost-effective.”

To support physicians, a portable app has been developed that allows physicians to easily compare therapeutic equivalency and costs when prescribing. This information is also available on-line. Evaluation of the initiative will include measurement of prescribing practices for four medicine groups in the coming year: anti-hypertensives, statins, proton-pump inhibitors and migraine therapies.

CIHI-Total-Drug-ExpenditureMany Canadian jurisdictions have introduced programs aimed at reducing drug costs. These include generic substitution policies (automatic substitution of an equivalent generic for a branded drug) and reference drug programs (insurance coverage for the lowest cost medication in a drug class, with a patient co-pay for higher cost drugs in the same class). In some cases, these substitutions are made by pharmacists without prior approval from the prescribing physician. These programs have been controversial among physicians who are concerned about a loss of control over their prescribing practices. There are concerns that drug substitution may result in lower effectivity or different side effect profiles than expected.

Previous studies have shown that Canadian physicians have generally positive attitudes and beliefs about the clinical and economic benefits of generic substitution, and to a lesser degree, of reference drug programs. However, it has also been noted that physicians face structural barriers to assuming a leadership role in cost-effective prescribing.

The Dutch program provides an alternative approach. First, the involvement of the Dutch medical association is likely to increase physician acceptance compared to programs that are perceived as government or insurer-sponsored and primarily aimed at reducing costs. Second, high quality decision support tools (the app and website, and potentially integration with e-prescribing) may make it easier for physicians to consider drug pricing when prescribing.

Drug spending in Canada represents an increasing proportion of total health spending, now more than expenditures on physicians. Between 1985 to 2008 Canadian total drug expenditure grew at an average annual rate of 9.1%, compared with 6.6% for total health spending. Results from the Dutch experience will help inform future initiatives on the controversial yet important topic of drug substitution to control costs.


1. Campaign Launch for Cost-effective Prescribing, Dutch Order of Medical Specialists
2. Does Knowledge of Medication Prices Predict Physicians’ Support for Cost Effective Prescribing Policies?. Polinski JM, Maclure M, Marshall B, et al. Can J Clin Pharmacol. 2008 Summer; 15(2): e286–e294.