Gerald Nash (Labour) | Oireachtas source

It is important we debate this issue of enormous public importance and concern. I welcome to the Visitors Gallery those who are affected by the denial of the opportunity to use Versatis in the future, as well as those who represent those experiencing chronic pain as a result of several conditions. I thank them for speaking out individually and collectively to raise public awareness of this critical issue and to ensure we are debating this matter of enormous public concern.

I was hoping at this juncture that the Minister of State would respond to public concerns by reviewing the original decision made. Unfortunately, given his demeanour and the statement he made today, it appears unlikely the Government is prepared to do that. Like other colleagues in this House and the Lower House, I have been contacted in recent weeks by constituents, and in some cases by friends, who rely on this particular treatment to ease or dissipate the chronic pain they experience. It is difficult for many of us to understand the lifeline Versatis represents if we do not experience the chronic pain that thousands experience and who are reliant on this particular intervention. Rearing a family, working, enjoying social events and having what might be considered a reasonable quality of life is denied to people because they do not have the opportunity to access this particular treatment as of right. These are things most people take for granted. The reality, however, will be a difficult one for those experiencing a variety of conditions and who are being denied the opportunity to access the treatment now and into the future. Everybody accepts that, even though we might differ on the response.

From the representations I have received and from my research, it appears this decision has been made for a combination of reasons. There are concerns over the efficacy, as reported, of the treatment for conditions outside of the post-shingles, nerve pain condition, as well as concerns over cost. I fear the real reason, however, this treatment has been essentially withdrawn for everyone who has access to it is a cost control measure dressed up as an efficacy issue. I understand this particular treatment has been prescribed extensively over the past seven years for pain associated with a wide range of different conditions. I do not have any difficulty in working with the system to look under the bonnet to establish the reasons there is extensive prescribing of this particular treatment outside of the area for which it was originally licensed several years ago. One reason, which Senator Paul Daly focused on earlier, is the two to three-year long waiting list for access to pain management specialists in the public health system. There also appears to be evidence to suggest that pain specialists in Ireland have been markedly more reluctant to prescribe opiate-based treatments for pain management than their counterparts internationally. These may very well be two important factors feeding into the extensive use of Versatis.

The market costs of Versatis are in the range of between €160 and €400 per patient each month. It is also known - it is to be hoped it is known in the system too - that this particular treatment will be taken off patent next year which will inevitably lead to lower costs. In the meantime, there is little evidence of any approach being made by the HSE to the manufacturers of this drug to make the case and negotiate for a reduction around cost. I understand the cost has gone from €6 million in the first year of its availability to €36 million over seven years. This is clearly as a result of the widespread growth of the prescribing of the intervention.

Due to a decision made by experts in this field, this intervention has been denied to many people who need this treatment just to function and manage the pain they experience every day. While not wanting to personalise the issue, I am also led to believe that Professor Michael Barry, when reviewing both the cost and the efficacy of Versatis, may not have availed of the opportunity to assess and consider other important evidence-based research from the United States and Germany, which supports and backs up the arguments made by patients and patient groups in recent days.It is important that the opportunity would now be provided to the system to review the issue of access to the drug and, in the context of any review that might take place, to ensure that the plasters would be restored to those who have relied on them. I understand that the NHS is undertaking a review of Versatis in the British system but I am led to understand that no patient there will experience a withdrawal of Versatis until those reviews are completed, the outcomes are known and the risk assessments are properly done in association and collaboration with consultants.

The opportunity should arise where this decision could be reviewed. I do not believe in pillorying anyone. I believe in persuading people. If a mistake has been made, experts and the political system should be given the space and opportunity to address them and to take on board any information that may have been overlooked or not considered when the original decision was taken because many thousands of people are now being denied the opportunity to have chronic, insidious and incessant pain managed properly. I appeal to the Minister of State to review the original decision to withdraw this particular treatment from the drugs payment scheme and the medical card scheme and, in the meantime, restore the opportunity to patients who need it to have this treatment. The review should be robust and it should engage with patient groups, individual patients and medical experts.