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The 4tx evaluates drug reimbursement requests 4rx viagra side on the five criteria: therapeutic value, price, proposed reimbursement tariff, the importance of the drug in clinical practice, and the budgetary impact of the drug [13]. The DRC may decide to compose a group of experts to evaluate the application. A proposal for reimbursement is prepared by the DRC within 150 days after the application. The final decision is made sids the Minister of Social Affairs within 180 days, after approval of the Minister of Budget has been obtained. After a negative advice, companies may enter into negotiations for managed entry agreements (in which for example, the pharmaceutical company refunds a predefined percentage of the price for every unit sold) as defined by the Royal Decree of December 21 th2001 [14]. Dupont and Van Wilder performed a qualitative analysis of Belgian reimbursement dossiers of all orphan drugs with a specific focus on the evidence related to the five reimbursement criteria (therapeutic value, price, proposed reimbursement tariff, the viagra nei giovanni dos of the drug in 4rxx practice, and the budgetary impact of the drug) [15]. They concluded that factors other than wide official criteria seem to play a role in the decision-making process, thereby creating uncertainty [13]. With a view to increasing accountability of decision-makers, there is a need for more transparency in viaggra 4rx viagra side that are taken into account in reimbursement decisions of orphan drugs [11]. Frameworks for the structured analysis of reimbursement decisions have been proposed [16,17].

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