Versatis cut: ‘Nobody deserves to live a life in daily agony’

It measures 10cm by 14cm. It looks like a dressing but it is more than that. The patch packs an analgesic – a pain-reliever – that many sufferers of chronic pain rely on to help them function day-to-day. Using it narrows the divide between living and existing, they say.

How well Versatis works was evident from the number of people ringing the Joe Duffy programme over several weeks, distraught at the news that the patch was no longer available free or partly paid for under the three community health schemes.

Those with neuropathic (nerve) pain after accidents or with arthritis, cancer, MS and more, talked of the quality of their lives deteriorating dramatically because they can no longer get the patches in the way they did.

The HSE changed the rules – Versatis shouldn’t have been prescribed as freely at all, they said, and it’s only licensed here for patients with post-shingles pain (post-herpetic neuralgia). There’s no real scientific proof it’s good for other types of pain, they said, but the users who were legitimately prescribed it by their doctors – those who experience severe pain on a daily basis – were saying on the contrary: “It does work, it’s been working and we need it to cope with the pain.”

Cost appeared to be behind the HSE’s move to rein GPs in from prescribing it so freely. It was costing the State over €30m a year and had to stop, they said. Approximately 25,000 people would be affected by the change, they told GPs. That works out at €1,200 per person for a year. It was after Christmas before many patients found out via their pharmacists that funding had been cut. Rosie Farrell was one of those patients.

One person’s story

Rosie Farrell works as a sub-editor for Irish Country Living and the Irish Farmers Journal. She is one of the people thrust into the spotlight in the fight for continued availability of Versatis pain patches, in her case via her Long Term Illness scheme (LTI). Rosie was diagnosed with multiple sclerosis in 2015 at the age of 25. She had a number of relapses in 2016 which left her with chronic pain and needing to use a stick and a wheelchair. She takes several strong tablets daily to manage her MS and chronic pain.

Versatis pain patches have been the difference between her being able to walk and go to work and not being able to do so.

“They take the edge off the pain so that I can cope,” she says, “and they don’t have the side effects that other drugs carry. That’s very important for people already on a lot of medication. Nothing gets rid of the pain entirely but the patches really help on days it’s flaring up badly. You’re only allowed to use them for 12 hours at a time and the top dose is three patches a day – what I’d use if the pain is really bad.”

CHRISTMAS SHOCK

Rosie first realised there was an issue with getting the patches on the LTI scheme just before Christmas.

“I was told that my Versatis patches were no longer being covered and that my GP would have to apply for approval from the HSE’s Medicines Management Programme staff before the pharmacist could give them to me on my LTI card again.

“I brought it up with the prescribing hospital and I was prescribed a low-dose morphine patch instead as they wanted to give me something to help the pain and there wasn’t much else left that they could prescribe for me given what I was already taking. However, I am 27 and morphine patches have far more side effects and are far more addictive than Versatis. My GP wasn’t eager for me to go on morphine because I’m already on a drug called Tramadol.

“The HSE talks about too many people using opioids (they can be addictive) and now here they are leaving doctors with only that option!

“My GP applied for Versatis for me but the application was turned down.”

TOLD THERE WAS NO APPEALS SYSTEM

Rosie rang the HSE to ask about making an appeal but was shocked to be told there was no appeals system. She only found out that there was an appeals process when she took part on the Claire Byrne Show on RTÉ in mid-February. A lot was said on the programme about it only being licensed for post-shingles pain but it was stated that it would be given to people with long-term neuropathic (nerve) pain if their doctors applied on their behalf.

MANY DRUGS PRESCRIBED FOR

OTHER CONDITIONS OFF-LABEL

In relation to Versatis only being licensed for those with post-shingles pain, Rosie says that there are many medications given to other people off-label.

“It doesn’t make sense. Shingles causes nerve pain and the patches help. Therefore they help nerve pain. My understanding is that the reason they have to be prescribed off-label is because there hasn’t been enough research funded to prove their effectiveness on paper outside of helping shingles. However, given the number of people using Versatis and the number of doctors who have prescribed it, it’s clear that the patches work for many people.”

FURIOUS AT TAOISEACH’S RESPONSE

On Tuesday, 20 February, An Taoiseach Leo Varadkar stated that it wasn’t a cost issue but a patient safety issue – Versatis simply isn’t licensed for all the conditions that GPs have been prescribing it for. How did Rosie feel about that statement?

“I was furious. If the Taoiseach is talking about patient safety, how can he tell me morphine is safer? What would he do in my position? Versatis would allow him to continue working where morphine patches wouldn’t.”

Rosie believes that everyone who suffers with long-term neuropathic pain should get the patches automatically if they are prescribed for them.

“At a minimum, all patients with persistent neuropathic pain should be able to get Versatis by default via the original application process. That would cut out a lot of the appeals paperwork, saving GPs valuable time and saving the State resources and money that are being poured into dealing with these appeals.”

MISUSE IN PAST?

But does Rosie thinks Versatis has been prescribed too easily in the past?

“Most people I talk to are getting it for persistent neuropathic pain, which Prof Michael Barry, clinical director of the National Centre for Pharmacoeconomics, which measures the cost-effectiveness of new drugs, said would be covered if your GP appeals.

“They say Versatis is prescribed less in the UK but I’d be interested to know what people in the UK with chronic pain are being prescribed instead of it. Are more people on drugs like Tramadol or Lyrica (pregabalin), for example, which can be addictive and have many side effects?

Seeing the BIGGER PICTURE

She believes the HSE has used “bulldozer tactics” in the way it’s bought about the cut to Versatis funding.

“Many GPs in Ireland prescribe Versatis because it’s not addictive and doesn’t get absorbed into the system and so therefore has no side effects. What are people now taking instead of Versatis and what side effects do these new drugs have? I don’t think the HSE looks at the bigger picture.

“They don’t consider the fact that people are able to work if they use Versatis. This keeps them employed and off social welfare.”

OPTIONS IF APPEAL REFUSED

So what are the options if your appeal is turned down?

“You can pay for the patches yourself if your doctor prescribes them,” she says.“Prices vary around the country from €120 to €250 for 30 patches. Many people are prescribed three patches a day, meaning it could cost you €360 to €750 a month if you buy them yourself. But who can afford that? It sums up our whole healthcare system really; if you have the money and can pay for it then you’re fine.”

Rosie has researched prices in Northern Ireland but prices in her home county of Sligo are similar to there – around €120 for 30 – probably because of cross-border competition.

Pitching illnesses against each other

Something else she objects to is Prof Barry continuously mentioning that the HSE can’t spend as much on Versatis because that money is needed for cancer drugs.

“It sounds as if Prof Barry is saying we have to save the lives of people with cancer and if we give you – those needing Versatis – these expensive patches, we can’t do that. It’s a ploy to sway the public. You can’t pitch illnesses against each other. There are many people undergoing cancer treatment who get prescribed these patches. Nobody, regardless of the cause, deserves to live a life in daily agony and confined to their sofa. That’s not living.

“The Government needs to stop making excuses and wasting money elsewhere. Healthcare needs better funding full stop. Some people are on the patches to help manage pain while they wait years for surgery. Removing these patches also increases the likelihood people with chronic pain will end up in agony in A&E departments. The whole healthcare sector is tied in together and you can’t start pitching it against itself!

Rosie Farrell is going to continue to fight for Versatis to be available to those who need it, she says.

“That’s because it’s my life they’re talking about. The Minister for Health wouldn’t want to live in pain so why should we?” CL

*Just before going to press, Rosie found out that her appeal was granted and she will receive Versatis on the LTI scheme until August, when she will then have to apply and appeal again even though her MS isn’t going away.