English speaking people with ADHD in the Netherlands

Laatste reactie 28/12/2020 15:22 door Nomen
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Cat Tavagnutti 5 maanden geleden geplaatst
Hi everybody!

I thought I would start this thread for expats/English speaking people in the Netherlands with ADHD and ADD who have been diagnosed here, or are pursuing treatment here. Since I have had a hard time understanding the Dutch insurance system, and matters of medication coverage and treatment, I would like to create a space where people can ask questions about it and help each other out. 

Since I spent a lot of time researching and stressing over it, I offer my experience of being diagnosed here this year and figuring out medication costs, in the hope that I can help someone else not to make the same mistakes I made (which resulted in paying my meds in full for a whole year - which, turns out, were on the fancy side and were quite expensive). Please bear in mind my own experience is limited, but there is no harm in asking and perhaps someone else in the community will be able to help out!

Have a great day, and remember to take your meds if you do!

Cat
Paul Visser 5 maanden geleden geplaatst
Hello there, 

You are not alone in having a hard time understanding the Dutch insurance system, and I can imagine it to be even harder as expat/English speaker. 

I am curious about your journey, would you like to elaborate a bit more about the mistakes you made and what you learned? 

If you have any questions about the insurance system or you need translation or whatever, feel free to pm me, I am happy to help. 

Paul




Cat Tavagnutti 5 maanden geleden geplaatst
Hi Paul,

Thank you for your response. It is really nice of you to offer help. Warning: long post ahead.

What happened was, I had no idea that there were going to be differences in medication coverage according to the insurance you have. Since I was referred to the ADHD specialist by my GP, I assumed that treatment and medication would be covered. In the past, I had taken other medication for other health issues, and as it was referred by my GP, they were covered. So you can imagine my shock when I found out I had to pay 80 euros per month for the ADHD meds, and it wasn't contributing to my eigen risico.

To be clear, the specialist that prescribed them to me did say that this was a new medication, Elvanse, therefore it was more expensive than the usual ones. He recommended it to me because of my personal requirements, and the limited side effects it gives in adults compared to Concerta/Ritalin. He also made it clear that, with the terugbetaalregeling scheme, I could claim back 250 euros per year for the Elvanse.

What I didn't understand at the time, was that the payback scheme was in place because this medication is generally not covered. It was not going to contribute to the deductible from my own insurance, so once the payback scheme ended, it all came down to me to pay it in full (eigen bijdrage).

After much confusion, frustration, several calls and emails, I understood why that was the case. The basic Dutch insurance offers coverage only for the most 'traditional' medications, like those based on metylphenidate.  Less common medication, like the Elvanse (lisdexamfetamine) is covered in full (or, at least, most of it) only if you have tried the more traditional ones and they didn't work for you. I do not know what the specific criteria are for these to be considered as non working for you.

This is what helped me figure it out, which I learned about through the Zilveren Kruis insurance helpline: https://www.medicijnkosten.nl/

I didn't even think this was going to be an issue I had to think about, until I got my first bill months later. The Elvanse worked wonders for me from the very start, and since it was a long journey to get diagnosed, I was relieved that I immediately found a medication that worked and I could complete my studies after a long hiatus. 

At this point, though, I won't be able to keep affording this medication in full, which means I will have to change to metylphenidates soon and see how that goes.

SUMMARY:

1) If you are not very familiary with the Dutch system, don't be afraid to ask questions. Calling works much better than emailing, as the immensely patient customer service lady from the Zilveren Kruis insurance was the one who could finally clarify the situation for me.

2) If you are prescribed a medication, first check with your insurance what type of coverage they offer for it and under what conditions. This private system is hugely confusing for many, and GPs and specialists sometimes do not know the full picture of coverage, because that ultimately comes down to the insurance itself and what medication they have contracts with. It can get frustrating to deal with these things with ADHD, so don't be afraid to ask for help and your wallet will be very happy in the future!

3) If any of you knows of insurance companies that offer good plans for ADHD meds, I would massively appreciate some suggestions. I am hesitant to switch to Concerta just for coverage issues, because of the potential for side effects, but I will probably have to give it a go to stop draining my finances. But if there is any insurance that offers good coverage for all types of medication, I am going to continue with Elvanse for sure. So yeah, I hope this helps anyone in a similar situation!
Paul Visser 5 maanden geleden geplaatst
Hi, 

Thank you for your cleary written post. 
This is very helpful to me because I also use Elvanse(and tried other types but Elvanse works best for me) but I havent looked at the financial consequences yet. I know I should do it but it is hard for me to start(and keep up) the process. 

So unfortunately I cant contribute(yet), but I will try to spend some time in the next two weeks to look into my situation and this subject. Any interesting findings will be posted here. 

I really hope I dont have to make the same decision you are struggling with and go (back) to Concerta or another type of medication. 

Have a great day, 

Paul 
Cat Tavagnutti 4 maanden geleden geplaatst
UPDATE: I got it (mostly) wrong. I need to clarify some of the statements I made.

I got my bills for the previous months, which made me question all I understood. Basically, when they say Elvanse is not insured, it means you pay the eigen bijdrage of max 250 and that's it?

I thought it meant that you could only be eligible to get 250 back, then you had to pay it in full. Instead, after I paid for the 250 EU all the rest of the medication fell under my eigen risico. Meaning that at the end of the day, the actual price you pay for any medication is your eigen risico only (since you can get the 250 bijdrage reimbursed through terugbetaalregeling afterwards).

The insurance helpline is swamped so I cannot get a final confirmation on this. In the meanwhile, I would like to know if this checks out for others! 

Sorry for the chaos, figuring these things out with ADHD is...a journey.

Wishing happy holidays for everyone!
Cat Tavagnutti 4 maanden geleden geplaatst
UPDATE 2: the bills I mentioned in the first post are actually the ones that contributed to my eigen bijdrage. Because they come in a few months later, I was extremely confused as to the month they were referring to. But I calculated it and I didn't pay more than 250 EU in eigen bijdrage.
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Topic gestart 10 December 2020 om 12:09
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