The National Health Care Institute (Zorginstituut) has raised concerns about pharmaceutical companies using a tactic called “evergreening” to extend drug patents and maintain high prices. This practice involves making slight modifications to a medicine just before its patent expires, granting it another ten years of patent protection.

The Zorginstituut has alerted the Netherlands Authority for Consumers and Markets (ACM) about these pricing strategies, signaling nine instances between 2024 and spring 2025, after having done so three times in 2023. These modifications, such as changing the method of administration or combining multiple active ingredients into a single pill, often provide convenience for patients but are primarily intended to prevent generic manufacturers from entering the market.

The institute warns that the current system is ill-equipped to address evergreening, as it can only regulate prices when the active substance is changed in the new patent application. Otherwise, the drug is automatically included in basic health insurance, leaving price negotiations to insurers and hospitals. The absence of effective measures against evergreening not only increases healthcare costs but also delays patient access to updated medicines and discourages the development of generic alternatives.

The Vereniging Innovatieve Geneesmiddelen (VIG), the industry association of pharmaceutical companies, defends the practice, arguing that patent protection is crucial for maximizing revenues from innovations in a competitive investment landscape. They contend that modifications are not minor and that they provide real benefits to patients and the healthcare system, such as simplifying medication administration.

The Zorginstituut’s recent horizon scan indicates a surge in new medicines and expanded indications for existing ones, with a notable increase in combination treatments that are often more effective but also more expensive. Without evergreening, price reductions of around 70 percent are common.