Medicines play a vital role in improving the health of Irish patients. Securing access to existing and new and innovative medicines is a key health service objective. However, the challenge is to do this in a safe and sustainable manner. Treatment must be appropriate and proportionate and clinical decision-making, such as prescribing, should be based on both patient needs and sound medical evidence.
Lidocaine 5% medicated plasters are licensed for localised relief of post-shingles pain in adults. This is the patch's only licensed use in Ireland. It has been reimbursed in the community drugs schemes since 2010.
Clinical concern arose when, from 2012 on, usage increased significantly, to the point where more plasters were being used in Ireland than in the entire UK National Health Service. In such situations, it is important and appropriate for clinicians to review usage and, in 2016, the HSE Medicines Management Programme (MMP) reviewed the use of the plasters. The review estimated that only 5-10% of prescribing was for the licensed indication.
From September 2017, following the clinical review, the HSE introduced a new reimbursement approval system for the patches, to support appropriate use and patient care. Under these arrangements, the patient's GP or consultant applies to the MMP for reimbursement approval on behalf of the patient. In the case of a negative decision, the treating clinician can appeal the decision.
As of 1 May 2018, there have been 6,250 online applications from clinicians requesting the reimbursement of lidocaine patches for a patient. Of these applications, 1,451 patients (over 23%) have been approved. Of 807 online appeals, over 70% of patients have been approved for reimbursement. The MMP has sought further information on another 71 appeals. Accordingly, since 1 September 2017, 2,019 patients have been approved for reimbursement of lidocaine plasters, based on the clinical case made by their GP or consultant.
It is clear that this new process supports appropriate use and prescribing and both post-shingles patients and other appropriate cases can continue to be treated with lidocaine plasters.
The HSE notified prescribers and pharmacies of the introduction of the new system in August 2017. This advice was re-issued recently, and information for patients and practitioners is on the HSE Medicines Management Programme website at www.hse.ie/yourmedicines.
This reimbursement decision is a matter for the HSE. However, I fully support the objectives of the HSE Medicines Management Programme.