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GPs told to limit costly new stroke drugs for medical card holders

DOCTORS are being told to ration expensive new drugs that can prevent strokes and opt instead for cheaper alternatives, the Irish Independent has learnt.

The blood-thinning medications Pradaxa and Rivaroxaban, which are new treatments and highly regarded by doctors, were given the green light to be used for medical card and other patients in recent months by the Health Service Executive (HSE).

However, doctors have now been told that the standard anti-blood-clotting treatment Warfarin -- which is considerably cheaper -- should remain the first-line treatment.

Many patients have already asked to go on Pradaxa because they don't have to undergo the regular blood tests needed with Warfarin.

But doctors who want to put patients on the newer treatments now have to get special permission first from health officials, according to a letter issued by the HSE.

This has led to criticism from doctors, who argue that they should be deciding the best prescription for a patient -- not the HSE.

A month's supply of Pradaxa costs around €143.70, compared with €2.13 for Warfarin.

The new anti-blood-clotting drugs are among a range of expensive medicines that were approved for use on state drugs schemes in recent months.

The HSE estimates that the new drugs -- which also involve treatments for cancer, hepatitis and multiple sclerosis -- may cost an extra €30m this year.

Around 32,400 people in Ireland are on Warfarin, the most commonly prescribed drug for people who have had a condition caused by a blood clot or are at risk of developing one.

The letter sent in recent weeks to consultants and GPs says while the new drugs represent the future of therapies, they "do present significant clinical, financial and operational challenges".


It said the new drugs should be reserved for existing patients on Warfarin who had poor control over their condition, or people who were taking other medicines that should not be mixed with Warfarin.

It can also be used as a first-line therapy by patients who are allergic to Warfarin.

Asked to comment on the HSE instruction, Dr Ronan Collins, a stroke physician in Tallaght Hospital Dublin, said: "One of the things that concerned me personally is that it is the doctor's professional duty to decide what is the best prescription for the patient, not the HSE."

He said those issuing the letters were not doctors.

"The (new) drugs are more effective than Warfarin in some situations but they are also safer, in that they are less likely to cause harmful bleeding," he said.

"I think when issuing prescriptions to new patients, the doctors' body of opinion is that the new drugs are better than Warfarin."

He said Warfarin was a more suitable treatment in the case of patients with kidney failure and added it would also not make sense to change to new drugs for patients who had been on Warfarin for many years, had good control and were used to it.

Irish Independent