Need for online reimbursement application for all DOACs ends on Sunday
Over the past seven years, the number of patients treated by direct-acting oral anticoagulants (DOACs) has climbed 10-fold as reimbursement application requirement ends on Sunday.
Effective from next Sunday, November 1 there is no longer a requirement by the Medicines Management Programme (MMP) to submit an online reimbursement application for any of the DOACs.
As experience in the use of DOACs had developed, the MMP deemed it “now timely to remove the requirement for a reimbursement application system for the licensed and reimbursed indications.â€
The reimbursement application has been removed for DOACs, apixaban, dabigatran, edoxaban and rivaroxaban, when prescribed for reimbursed licensed indications, including the prevention of stroke, and systemic embolism in adult patients with non-valvular atrial fibrillation, management of deep venous thrombosis (DVT) or pulmonary embolism (PE) and prophylaxis of thromboembolism in adult patients following elective total knee replacement or total hip replacement.
However, Prof Michael Barry, National Clinical Lead, MMP highlighted that low-dose rivaroxaban at a dose of 2.5mg twice daily, in combination with aspirin, for the secondary prevention of cardiovascular disease was not reimbursed at this point in time.
Over the past seven years the number of patients being treated with DOACs had increased over 10-fold from 6,805 to 71,942 with total expenditure increasing nine-fold to just over €63 million per annum.
Warfarin now accounted for just 15 per cent of all 84,393 patients currently in receipt of oral anticoagulants.
The MMP recommended apixaban as the preferred DOAC and that warfarin was an appropriate first-line treatment option when the time in therapeutic range was 70 per cent or higher.
Clinicians were reminded that the prescribing of DOACs was complex with different dosing regimens for the various therapeutic indications, the possibility of drug-drug interactions and the increased risk of bleeding in elderly patients, due in part to deteriorating renal function.
The Programme had published anticoagulation prescribing tips and tools which may be found on its website.
Reimbursement application systems are to continue to be required for some high cost and/or high budget impact drugs to ensure such medicines are used in a cost-effective way.
