Jim Daly (Cork South West, Fine Gael) | Oireachtas source

I thank the Senators for their contributions. I am always appreciative of the constructive, solution-led contributions that come from the House. They are more generous in this House than others. It is easy to give out, punch the air on these things and take the populist route, but I always appreciate that many Members in this House go to a lot of effort to come up with solutions and alternatives as well. I have listened to and will take on board the contributions and progressive suggestions of Members today. Of course we can do more to address the issue and we can put pressure on the HSE to see that the market value for this particular patch is as efficient as it has to be. We can examine how the entire saga has been handled because it would be preferable, as Senator Nash remarked, if the scheme is to be closed, that it would be closed to new entrants. That is basically what he was saying. We could pick up the trends earlier where prescribing has been strong.

We are where we are, however, and I am concerned about the worry and upset that I have heard from patients. I understand why people felt that they had to air their concerns and they were right to do so. I want them to know that we have been listening and I want them to receive the compassion that they deserve in seeking treatment. I am also conscious of the fact that treatment must be appropriate and proportionate and that clinical decison-making such as prescribing should be based on both patient needs and sound medical evidence. There is no getting away from the fact that this has been a clinical decision which is aimed at ensuring the most appropriate patient care. Prescribing must always be appropriate and proportionate, making sure that any treatment is the right one. Any medication used incorrectly can have adverse consequences for patients, and this is why medicines are controlled by national and international legislation.

The new reimbursement arrangements, which I outlined in my opening statement, were brought in by the HSE to address what was in its view a significant level of inappropriate use of this prescription medicine. As I stated, under the new arrangements, all patients with the licensed and approved indication remain on the plasters. At the same time, it affords all other patients the opportunity, through their GP, to make a clinical case for continued use for their specified indications. There is nothing new in these arrangements. The HSE already uses such systems for a number of other medicines. The new system follows the recommendations of the clinical experts. It uses the licensed specified indication as the baseline for reimbursement approval. Treatment is not always straightforward, however, and any system must be able to address exceptional cases. This is why the new arrangements allow doctors to make a case, through the appeals process, for non-shingles patients who they feel would benefit from this product and for whom it is, in their view, an appropriate treatment.

A responsive system should always avoid administrative difficulty. As I have mentioned, the online system allows decisions on both applications and appeals to be made within days. Of course, the GP must provide clinical information to support a decision. That is as it should be so that the treatment is used appropriately, as for any other prescribing decision. In that context, I was delighted to see in recent days statements from the Medical Council, among others, on the ongoing development of decision-making support for prescribers through information and undergraduate and continuing education. I hope that this will continue to be built upon.

I am advised by the HSE that the new arrangements are addressing exceptions where the evidence is strong. Currently, nearly two thirds of appeals for non-shingles patients have been granted on the basis of the clinical case made by the patient’s GP. We are listening. We want patients who have an identified and certified clinical need for this product to have access to it under the community drugs schemes. I am pleased to note that the HSE appeals process is taking a compassionate approach so that anyone who needs these plasters, on the basis of a clinical case made by their GP, can have access to them.

I thank the House for the invitation to address it on this important matter.