Versatis Patch - Keeping you updated

April 26th, 2018

19/07/18

CPI currently have 2 members who have as yet to have their patch reinstated. For those of you reading this update who are still without your patch, if your GP has refused to appeal you can write or email the MMP (mmp@hse.ie) directly simply stating that "My GP (enter name and address) has refused to engage with the Versatis appeals process" and give your contact details.  If your appeal has been refused you can make a case directly.

You need to make a case for yourself both economically and clinically.  

  • When you had Versatis patch (if you took other medications, list them).
  • Now you are without Versatis (list all the medications you now take)
  • List what daily functions you now find difficult as a result.
  • If you are getting support from carers/family what impact has this had on you/carer/family.
  • If you are incurring additional costs i.e. private cleaning/cooking, increased home help hours, list them and the costs.  
  • If you had been taking the patch due to inability to take other medications due to the impact on kidney/liver function, heart, diabetic condition etc., list that in your correspondence to the MMP. 
  • Have you lost days of work as a result of withdrawal of Versatis?
  • Have you attended hospital as an in or out patient for treatment of pain since withdrawal?
  • Provide copies of as much medical supporting documentation you may have – e.g. consultants reports, hospital discharge, physiotherapy, OT etc.

Reimbursement of costs.
CPI have been looking into whether patients can apply for reimbursement of the costs they incurred while having to pay for versatis privately.  Following our query to the Primary Care Reimbursement Service PCRS (01) 8343644 we have been informed that they need to speak to patients individually however the only way a person who has won their appeal can try to get reimbursed for the time period they had to pay for Versatis is by Med1 (Tax). They cannot use the usual reimbursement application as Versatis was not approved, at that time, and the pharmacy would not have been paid by the medical card or drug payment schemes.

CPI are to follow up on one of the points outstanding from our meeting earlier this year with Prof. Barry and we will keep you appraised of progress. 

If you would like assistance please have no hesitation in contacting us at info@chronicpain.ie or call 01 8047567.

 

26/04/18

Chronic Pain Ireland are delighted to announce that following last week's meeting between Prof. Barry (MMP), CPI's Olivia Shiel and John Lindsay regarding versatis, all GP's are to receive notification of our meeting and the outcome of same.  The Chairperson of the National Association of General Practitioners (NAGP) has confirmed that they are forwarding the CPI notice to all GP's nationwide shortly.  

Some members informed us of their difficulties which included GP's unaware versatis appeals process allowed appeals based on persistent neuropathic pain conditions and some GP's refused to appeal given the time it took to complete same.   We sincerely hope that GP's on reviewing our update circulated by the NAGP will reconsider and appeal via letter to Prof. Barry on behalf of their patients.

We feel the above is a significant step forward in addressing the feedback from a small number of members regarding their GP experiences and we hope that we will shortly see them reinstated with this medication.

 

18/04/18

John Lindsay, Chairperson Chronic Pain Ireland and Olivia Shiel Governing Body held a meeting with Prof. Barry earlier today.  The following are the main points from Chronic Pain Ireland's meeting with Prof. Barry in relation to the non-reimbursement of Versatis 5% Lidocaine patch. 

1. If you have been successful in your appeal you will not need to reapply after 6 months. Your physician just renews your prescription.

2.  While Versatis is approved for Post Herpetic Neuralgia, appeals will be looked upon favourably if your diagnosis is Persistent Neuropathic Pain. However where there are extenuating circumstances and your physician outlines in detail the extenuating circumstances those appeals will also be favourably treated irrespective of the underlying medical condition.

3. Many GPs have complained about the time it takes to complete the online appeal application even though there are only 6 questions to be answered. A letter from your physician will suffice and should be sent by post to Prof. Michael Barry, Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St. James Hospital, Dublin 8. We suggest that you ask to your physician that she/he does the latter which, in the words of Prof. Barry, will just take the time it takes to dictate a letter.

4. We have asked Prof. Barry to discuss and review with his colleagues in the HSE MMP the possibility of allowing consultants, who are specialists, to prescribe Versatis off label. 

Should you have any concerns please have no hesitation in contacting Chronic Pain Ireland by email at info@chronicpain.ie or by phone 01 8047567

08/03/18 Appeals process in breach of Data Protection Act

Chronic Pain Ireland have lodged a complaint with Prof. Barry stating that the appeals process is forcing GPs to be in breach of the Data Protection Act. This is in line with the advice we have received. We have asked for an immediate review to ensure compliance. This may have implications for previous applications which were refused and will certainly impact on future applications. However it is possible that Prof. Barry as head of the HSE MM Programme may reject the complaint and that will start the a process of an appeal to the Data Protection Commissioner. Please note that if you do appeal your personal medical records are going to be shared with a third party who is not a member of the medical profession. 

We have also written again to the Minister for Health outlining a number of issues which we have asked him to raise with Prof. Barry and we have outlined our proposal in relation to the future prescribing of Versatis. We will keep you updated.

05/03/18 Public Meeting in Cork

Chronic Pain Ireland invited to speak at public meeting in CORK supporting the campaign to restore the Versatis Patch. CPI Chairperson John Lindsay, Jonathan O'Brien TD Junior Spokesperson on Finance and Public Expenditure & Reform, Donnchadh Ó Laoghaire TD, Pat Buckley TD and Liadh Ní Riada MEP along with representatives from PatchusBackUp are in attendance. Both PatchusBackUp and Chronic Pain Ireland addressed all present.  During our presentation to the group, Chronic Pain Ireland explains our ongoing strategy and thanks all present for their ongoing committment and support of this issue.

01/03/18

Dr Camillus Power Consultant Pain Specialist and Director of Ulysses Programme, Tallaght University Hospital continues to speak out with Ivan Yates on The Hard Shoulder. Our sincere thanks to Dr Power for his support.

22/02/18 Reports of difficulty with applications

Some patients are reporting difficulty getting their GP to make the application online to appeal the decision to refuse reimbursement in relation to Versatis.  CPI contacted the Irish College of General Practitioners (ICGP) for their opinion in relation to this matter. Their response is that the ICGP are supportive of the recommendations of Prof. Barry and that GP's do not have to carry out any work for which they are not paid.  It was suggested in a personal capacity (and not as  as a representative of the ICGP) that those having difficulty persuading their GP to make the appeal....... might offer to pay the GP for the work involved.  Chronic Pain Ireland holding a meeting for our members to discuss this and all issues surrounding the ongoing versatis case on Sunday 25th February in Dublin.

21/02/18 Dr Camillus Power states Taoiseach's views are beyond comprehension

Dr Camillus Power, Consultant Pain Specialist and Director of Ulysses Programme, Tallaght University Hospital spoke out on RTE Liveline today.  In response to the Taoiseach's Leo Varadkar latest Dail statement where he is quoted as stating "the decision to restrict the supply of the pain patches is right",  Dr Camillus Power, says the Taoiseach's views are "beyond his comprehension".  Listen here Further debate took place in the Seannad with Senator Rose Conway-Walsh reiterating the need for the Minister for Health to review the HSE decision on access to Versatis patches pain medication. CPI along with FibroIreland and Arthritis Ireland were in attendance.To read full debate see https://beta.oireachtas.ie/en/debates/debate/seanad/2018-02-21/17/

15/02/18 Versatis

This morning Chronic Pain Ireland (CPI) represented by John Lindsay (Chairperson), Deirdre Ryan (Governing Body) and Mary O'Caroll (CPI member) attended and spoke at a briefing session in Leinster House.  Mr Brian Lynch from Arthritis Ireland was also in attendance and also spoke.

CPI Chairperson briefed those present on what CPI has done to date on the issue around the withdrawal of reimbursement of the patch, our research and interaction with Prof. Michael Barry and the acceptance to allow appeals for those with persistent neuropathic pain. Chairperson John Lindsay also stated that we took great exception to the manner in which it was withdrawn and that patients should be left on the patch until the prescribing doctor deemed it clinically safe to do so. CPI also explained what off label prescribing meant.

Deirdre spoke about her experience of having fibromyalgia and the position patients are in relating to the patches. As fibromyalgia isn’t categorised under one specialty i.e. rheumatology and/or a pain specialty, patients are left with the uncertainty of who to contact or whether they are eligible to do so.  Deirdre displayed the guidelines given to GPs on recommendations of substitute treatments and how it focuses on fiscal benefits rather that the clinical evidence of their efficacy. Deirdre also mentioned while Prof. Barry has also suggested substituting the patches with other ‘off label’ medications such as Amitriptyline this evokes fear in patients of which medications that are currently being prescribed ‘off label’ could be withdrawn next.  

The manner in which the patches were withdrawn unjustly undermines the patient-doctor relationship and burdens the GP with the administration.

Mary O'Caroll spoke from the patient’s perspective and also as a user of the Versatis patch. Without the patch she told those present that she will be house bound.

A summary of the meeting will be sent to all members of both houses of the Oireachtas and next week a debate in the Seanad will take place and CPI have been invited to attend.  We will keep you updated.

14/02/18 Versatis Appeals Process Update

When appealing a GP/Consultant should include any additional information to support unmet clinical need for versatis based on failure of other treatment options. Appeals are on a case-by-case basis reviewing the information provided in the initial online application and the information in the appeal submitted to MMP. GP is notified of decision via letter. GP can appeal directly via mmp@hse.ie or can write to Prof. Michael Barry, (Clinical Lead, MMP), Dept. of Pharmacology & Therapeutics, Trinity Centre for Health & Sciences, St James Hospital, Dublin 8.

13/02/18 Versatis Withdrawal and Appeals process for persistent neuropathic pain
Following a week of members and general public calls to LiveLine, CPI were invited to take part in Monday's RTE Claire Byrne Live show and members following the HSE's decision to withdraw versatis for people with a medical card or the Drug Payments Scheme and our members expained how the withdrawal of versatis had impacted them.  During the show Dr Michael Barry of the Medical Management Programme stated that GP's treating patients who have neuropathic pain should use the appeals process. 

Chronic Pain Ireland recommends that if you have retractable (i.e. persistent neuropathic pain) to appeal. If you have already appealed and have been refused reimbursement of #versatis you can get GP or Consultant to appeal against the decision. What is really import in the appeal process is that your GP / Consultant MUST state that all the recommended treatments have been tried and have failed in your case. It must be a good concise submission, clearly stating the above. Please let us know if you had appealed and were refused, but also keep in touch with whether you are making an appeal and indeed what happens after your appeal is submitted. Best of luck to all and our thanks again to all who have spoken out