[Separate pharmaceutical budgets: skating on thin ice].

In the Netherlands there are separate pharmaceutical budgets for hospital, nursing home and primary healthcare. This complex method of funding drug use, plus three recent developments, is putting increasing pressure on patient access to adequate pharmacotherapy. The three developments concerned are: the rapidly increasing number of expensive drugs available; the transfer of complex hospital care to primary care; and the transfer of budget responsibility from the government to health insurance companies. The so called 'postcode lottery affair' is just one example of access to expensive drugs (e.g. trastuzumab) depending on the region in which patients live. A reform of the way pharmaceutical budgets are distributed needs urgent reconsideration.