ADHD meds already cut for everyone – but health fund says it’s a problem | New
Karoliina Elizabeth Pettai was diagnosed with ADHD as an adult. The first time she had her prescription for Medikinet XL 20mg filled, she paid the full price, without discount, of around €29 for the box. In mid-July, she called her family doctor to ask for a refill and noticed, while checking the online patient portal, that this prescription had been issued with a 90% discount rate.
“I thought it was some kind of mistake and I would still have to pay full price at the pharmacy, but when I got there I paid less than €3,” Pettai told ERR News on Friday.
Then, earlier this week, Pettai went to the psychiatrist, where she was prescribed Concerta 36mg instead – another drug with the same active ingredient as Medikinet, methylphenidate, but a different formula and release profile. – and was told it would cost €80. Shocked by the price, she mentioned that she had recently been able to buy Medikinet at a reduced rate, and added that she had read in an Estonian ADHD support group on Facebook that several other people who were not eligible previously had suddenly been able to buy their medications at a discount recently as well, but the prescribing psychiatrist made a few calls and confirmed that no, she was in fact not eligible for a discount.
Preparing for the worst, Pettai then went to the pharmacy. To his surprise and confusion, his Concerta prescription, which should have been €52, only came to €11.
Glad she was able to buy her new drugs at a discount after all, she sent a photo of the receipt to her psychiatrist, but the psychiatrist replied that they had been in touch with Getter Hark, Chief Pharmaceuticals and Medicines Specialist. EHIF medical devices. Department, which confirmed that Pettai’s prescription issued to him at a discount was a mistake.
“Yesterday I was really happy to see the reduction again, but after talking to [my psychiatrist] again, I am now even more confused and sad,” she said. “It had given me hope that I would save more money, but now I don’t know what to think. “
Pettai is not alone. Since July 18, who recently got ADHD medication at a discount has been a hot topic of discussion in the Facebook ADHD support group, and commenters have wondered if it’s possible the ministry’s settlement of Social Affairs governing medicines available at reduced prices for which had already been modified.
That seemed dubious, given that the Chancellor of Justice had just released her six-page statement regarding the unconstitutionality of only adults diagnosed with ADHD before they reached the age of 20 being able to purchase their ADHD medications at a reduced rate. In addition, the Chancellor had given the ministry a deadline of August 8 to resolve the discriminatory gap.
On July 19, Olari Koppel, Director of the Office of the Chancellor of Justice, confirmed to ERR News that their office was indeed not aware of any changes, noting that the EHIF had not yet responded to the letter from the Chancellor of Justice.
EHIF Manager: It’s just a coincidence
On the same day, EHIF told ERR News that people suddenly being able to buy their ADHD medications at a discount was actually due to a technical glitch.
“No substantial changes to ADHD medication reduction have yet been introduced,” said EHIF spokesperson Sander Rajamäe. “Some adult patients who were not treated as children may currently be eligible for discounts on these drugs due to a general technical error which we are working to resolve. Pharmacies are aware of the issue and have been advised to check the reduction rates issued by the prescription center and to adjust them in cases where they do not correspond to what is written on the prescription issued.
This also follows Hark’s email response to a query from Pettai, where the EHIF specialist explained that the prescription center is applying discounts on ADHD medications not because of changes in conditions, but rather because of due to a technical error.
Hark noted, however, that the Estonian Psychiatric Association (EPL) had submitted a request on July 8 for several ADHD drugs to be included in the list of prescription drugs eligible for discounts for all, and that this request was being processed according to the routine procedure. . “The current situation is just an uncorrelated coincidence,” she added.
According to Rajamäe, EPL’s application passed initial review by EHIF and was forwarded to Estonia’s National Medicines Agency on July 11. EHIF assessments and the recommendation of the medicines commission,” he explained.
Checking eligibility for rebates under the old, tougher rules on the pharmacy side should have “ripped out that possibility by now,” Rajamäe added, but well over a week later people are still exchanging stories. on social networks about the possibility of buying their medicines. for cheap.
Ly Rootslane, board member of the Estonian Pharmacy Association (EPAL), also told ERR News last week that “when a medicine is dispensed, the digital prescription center software automatically checks whether the rate discount is valid; the pharmacist does not modify it. “
“I hope this problem is made permanent”
It’s unclear how long this apparent fluke at the confluence of multiple factors may last, but many, including people who take the ADHD medications eligible for discounts themselves, are hoping change is here to stay. last.
“The unexpected expansion of rebates due to a problem in the EHIF system raised the hopes of many that the EHIF had taken decisive action in light of the position of the Chancellor of Justice and given patients’ constitutional rights first,” Ott Oja, director of the Estonian Coalition for Mental Health and Wellbeing (VATEK) said on Friday. “It was disappointing to learn that this was a system error and that EHIF is working to restore the [previous] discriminatory situation and that we will probably have to wait several more months for real change. »
Triin Kliss, a founding member of the non-profit organization ADHD Estonia, told ERR News that she used to pay between €64 and €88 per month for her ADHD medications, but now she can buy them for just €23.
After returning to Estonia from abroad, Maria Palgunov was also pleasantly surprised with the same reduced price.
“I was diagnosed [with ADHD] and I received my first medication in South Korea,” she explained. On July 12, she saw a psychiatrist in Estonia and was prescribed Medikinet here for the first time, where she was not entitled to a reduced rate. “I was ready to pay close to €100 for my prescription. On July 18, I went to the pharmacy because I had no more Medikinet that I had bought abroad, and surprise — instead of €88.44, I paid €23.98.”
Palgunov said that even in South Korea, which she described as very conservative when it comes to mental health, she paid even less for her medication than that – around €5 for a pack of Medikinet 30mg.
“When I came back to Estonia, I was very surprised that our health insurance fund didn’t pay anything,” she said. “Private health insurance also only covers €50 of prescription drugs, and as far as I know, this doesn’t even apply to psychiatric drugs. I hope this discount problem will be permanent.”
Prescription drugs or food on the table
As gas prices remain high, another winter of high energy prices looms and Estonia records the fastest annual inflation rate in the EU for the third consecutive month — 22.7% in July according to a Eurostat rapid estimate published on Friday —those whose quality of life depends on expensive drugs are particularly vulnerable.
For some, whether or not they can buy their ADHD medication at a reduced price can mean the difference between treating their ADHD or not – a reality that even Chancellor of Justice Ülle Madise alluded to in her letter to the Department of Social Affairs earlier this month.
“I was only recently diagnosed with ADHD,” Kristi Vahtler said. “All my life I’ve wondered why I’m weird like this and it wasn’t until an adult that I was finally able to reframe all my struggles as challenges and make peace with it all. J even started loving me just the way I am.”
Nevertheless, the last few years have been very difficult for Vahtler. The end of a decade-long relationship left her and her young child in financial trouble, and to this day, she must count every penny just to get by.
Vahtler found a job she loved, but after a series of warnings for mistakes at work, her career was hanging by a thread – which is why her hands shook when she went to the pharmacy recently to filling her very first prescription for Medikinet.
“I had heard that these drugs were expensive, and to be honest the whole situation was absolutely depressing for me, considering the situation I was in,” the single mother said. On the one hand, it was the very last of his money; on the other, she was afraid of losing her job. “It was my last hope.”
Then the pharmacist phoned her prescription and she did a double take. “My medication costs something like €8 and I was in heaven,” she recalls. “I was so grateful and I felt like my life was going to change right then and there. And that’s what happened.”
Vahtler said she was a completely different person when medicated — in a good way. “I can write instructions for three hours in a row without a break, whereas before even half an hour was difficult, and ten things were popping up in my head at once,” she described.
After a lifetime of struggles, many adults who are finally diagnosed and started on ADHD medication report huge differences at work, school as well as in their personal lives, often describing their experience as similar to that which ends. by getting essential glasses for the first time.
“I can’t imagine my life without Medikinet anymore,” she said. “But it will be very sad if I find out at some point that I can’t buy it anymore or I can’t put food on the table for my child or gas in the car to take my child to kindergarten and myself to work, because logistically I have no choice but to drive.”
Like many, Vahtler sincerely hopes this misguided discount becomes permanent. “Because otherwise my quality of life will improve on one side and deteriorate on the other,” she said. “Maybe they will understand that this shouldn’t be a mistake, but normality.”
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