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 drug schemes since 2010.
Clinical concern arose as 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. If an application is refused, the clinician may submit an appeal to the MMP, making a clear clinical case for the patient. Information for patients and practitioners is on the HSE MMP website at: hse.ie/yourmedicines.
The outcome of an application or an appeal for reimbursement of lidocaine patches is a matter between the MMP and the treating clinician. The Deputy will appreciate that, as Minister for Health, I cannot intervene in individual cases.
The decision to introduce a new reimbursement approval process for a particular treatment is a matter for the HSE. However, I fully support the objectives of the HSE Medicines Management Programme.