Health Minister Stephen Donnelly says the number of women seeking reimbursement is slightly ahead of projections in terms of the funding allocated. Alamy Stock Photo
severe vomiting

Obstetrician: 'Some women with Hyperemesis are choosing not to continue with their pregnancy'

Consultant obstetrician at the National Maternity Hospital Professor Mary Higgins says GPs should be able to prescribe Cariban.

WOMEN WITH A severe vomiting illness during pregnancy are suffering from mental health issues, with some choosing not to continue with their pregnancy, according to a consultant obstetrician at the National Maternity Hospital and assistant professor at UCD, Professor Mary Higgins.

Speaking at a briefing this morning on the current approach to the reimbursement of the drug Cariban, which helps ease the illness, Higgins said not giving women timely access to the drug and making patients jump through hoops to get a prescription is having devastating impacts on women’s mental health.

The briefing, organised by Social Democrats TD Jennifer Whitmore, was attended by representatives of the advocacy group Hyperemesis Ireland and members of the medical profession, including Professor Higgins.

Women, doctors, and pharmacists have criticised the roll out of a new scheme to reimburse women with the cost of the drug that helps with severe sickness during pregnancy, specifically hitting out at the need for a consultant to give the initial prescription to women.

The drug, known as Cariban, was previously unavailable on the drugs payment scheme or medical card.

As part of a major campaign women impacted by severe vomiting – known as Hyperemesis Gravidarum or HG – called for the State to reimburse expenses for Cariban, which can cost up to €3,000 over the course of a pregnancy. 

Budget 2023 set out that funding of €1 million would be set aside to facilitate reimbursement of the drug, however, since its implementation this year, criticisms have been levelled at the barriers that have been created for women.  

Speaking today, Professor Higgins said Cariban is safe for use, is one of the most researched and peer-reviewed drugs available, and is prescribed and used in all maternity hospitals in Ireland.

The new scheme was rolled out without any consultation with consultants, she said who are now required to fill out the prescription forms. The first she heard of it was when one of the forms was presented to her in the hospital one day.

Hyperemesis is a “normal complication of pregnancy – a pretty horrible one” but GPs should be allowed to prescribe for the drug, argued Professor Higgins.

She is calling for easier access for women, stating that it must be more patient-centered, which the new system currently is not. 

Every Tuesday afternoon, the National Maternity Hospital holds a clinic specifically for their patients with hyperemesis, where they are seen by psychologists from the mental health team who talk to women about how to deal with living with HG during their pregnancy.

Many women suffering from it do not know much about it, and are struggling with how to care for their other children and how they deal with not being able to work due the illness.

Professor Higgins said many of the women find themselves in a very “dark place”. She said she knows of women who have contemplated suicide, “which is a horrible thing to think of at the time of your life, which is meant to be a joyful time in life”, she said.

Some women she knows have unfortunately chosen not to continue with their pregnancy, she said.

Women can sometimes lose so much weight due to getting sick so often in the day that they must be fed by a tube, she explained. 

Such is the need for the medication for so many women, that during the ‘Beast from the East’ snowstorm some years ago, Professor Higgins said the husbands of some of her patients actually walked through the snow for a couple of miles just to make sure they could get Cariban for their wives. 

“So that’s how much people needed it,” she said.

A number of politicians at the briefing this morning raised the issue of the level of the reimbursement costs and the funding provided in the budget, highlighting that underestimating the number of women availing of the drug could be the issue. 

In a Dáil contribution today, when asked about the issue, Health Minister Stephen Donnelly said:

“I believe the number of women who have been approved for the product is 144 as of today. This is slightly ahead of projections in terms of the funding allocated,” he said.

“Cariban is not a licensed product and this means there was no normal mechanism to make this drug freely available. We cannot compel the company to do this…

“What we can do is to ask that there be engagement from the HSE with these companies to see if they would like to begin the process.  This is certainly something I would support,” he said. 

Professor Higgins said while some women end up being hospitalised due to HG and its effects, the whole point of giving women early and easy access to Cariban is to avoid hospitalisation.

Campaigners, including medical experts and GPs have queried the rationale of stating that unlicensed products cannot be reimbursed, stating that there are a list of other drugs, which are also unlicensed, which are prescribed regularly for other illnesses.

Since the onset of complaints since the new system opened in January, Donnelly has initiated another review into the scheme to see if issues could be overcome.

However, those present at the briefing today said there has been no information about the form in which the review will happen and who is carrying out the clinically-led review.

Professor Higgins stated that the system must be more accessible, stating that the maternity services, which are already under pressure are having more work heaped on them, which is not serving anyone, especially patients.

Fianna Fáil’s Christopher O’Sullivan, who attended the briefing today, said the HSE are still resisting the move to allow GPs to prescribe Cariban and have it covered under the drugs payment scheme.

“That’s the feedback I’m getting. I know the Minister for Health wants GPs to be allowed to describe Cariban so we need to keep this campaign up and ramp it up,” he said.

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