A new online system for approving patients for Versatis pain-relief patches has been criticised by one highly placed GP, who says it is placing an undue administrative burden on doctors’ surgeries.
Dr Andrew Jordan, who is chairman of the National Association of General Practitioners, said the system introduced at the end of last year was taking too much time and that almost all GPs' applications on behalf of their patients for the patches were now being turned down.
“You are absolutely wasting your time, or your practice secretary’s time and the currency of general practice is time. Somebody has to pay for that time and this is just not fair,” he said.
Off-licence purposes
The medicated patches, which contain the anaesthetic lidocaine, were effectively removed from the State’s drug reimbursement schemes, including the medical card scheme, at the end of last year after the HSE said they were being “inappropriately” prescribed by GPs for “off-licence” purposes.
Some estimates suggest that up to 25,000 people were using the patches and that up to 90 per cent of the prescriptions were for purposes other than the officially licensed use.
While the patches are officially licensed only for the treatment of pain after shingles (known as post-herpetic neuralgia, or PHN), consultants and pain specialists have been prescribing them to other patients with a wide range of other symptoms, where they claim to get enormous relief from them.
Dr Jordan said he was telling patients that the patches were now effectively off the market. However, doctors would now turn to “less desirable” drugs such as codeine, to treat their patients’ pain.
Petition
A group of female sufferers of chronic pain, among them Barbara Doheny, launched the "Patch Us Back Up" campaign urging the Government to restore the reimbursement for the patches. Ms Doheny said the group had collected over 11,000 signatures in a petition and was planning a march to the Dáil.
After concerns were raised by Ms Doheny and other patients on RTÉ's Liveline in recent months, Taoiseach Leo Varadkar told the Dáil the withdrawal of the patches from the drug compensation schemes was "a matter of patient safety".
“It is an anaesthetic and not something one should prescribe lightly,” he said.
Minister for Health Simon Harris has said the projected budget impact when the patches were introduced to the scheme in 2010 was low due to the specific licensed indication. Total expenditure had, however, trebled between 2012 and 2016, from €9.4 million to over €30 million, mainly from off-licence use for pain not associated with shingles.
“For many of the conditions applied for, prescribing the patch was inappropriate, for example, for conditions such as deep venous thrombosis, angina, gout and endometriosis,” Mr Harris said.
Online process
GPs must now go through an online process (via the Medicines Management Programme) to apply for approval for each patient for whom they wish to prescribe the patches. So far, the programme has received more than 4,700 applications, of which only 14 per cent have been approved.
Dr Jordan, a GP in Tallaght and Terenure, said it was not appropriate that the organisation take a collective view on the matter, because it related to clinical issues and prescribing.
But in his own experience as a GP, most of the Versatis that had been prescribed was where GPs were writing repeat prescriptions that had been initiated in hospitals and particularly in specialist pain clinics.
“You have a patient coming to you who is attending a pain specialist in a pain clinic, you’re not going to turn around and change the prescription that the specialist has given them, unless there’s a very good reason. We wouldn’t have felt it was appropriate to interfere with that,” he said.
But Dr Jordan said GPs were taking on a medical and legal responsibility and there was now “a pushback” in relation to the new application system which was costing GPs a lot of time.
He said he agreed that the HSE should save money on drugs and there was no benefit to GPs to prescribe drugs that were expensive. But statements from members of the Government about patient safety had just “looked silly” and their claims that the withdrawal was based on patient safety was “utter nonsense”.
“I’ve never seen any paper or document or warning anywhere that the long-term use of lidocaine would be in any way dangerous or disadvantageous to a patient,” Dr Jordan said.
The HSE says it gave doctors and pharmacists over three months’ notice of the changes before they were fully implemented in December 2017 in order to give them time to communicate them to their patients. They were also given prescribing hints and tips outlining “suitable alternatives”.