In February 2021 we launched a campaign called #HG 2costly, calling for the first line treatment for Hyperemesis Gravidarum to be reimbursed on the Drugs Payment Scheme and Medical Card.
The first-line treatment is doxylamine/pyridoxine, available in Ireland under the brand name Cariban. Other brands are licensed, but not marketed here, despite contact from us. One other brand, Xonvea, was rejected for reimbursement in 2019.
In response to the campaign, the HSE and Minister for Health gave various reasons why Cariban could not be covered:
- Cariban is unlicensed: this is true, however other unlicensed medications are covered under the community drug schemes and regularly prescribed by GPs e.g.: Utrogestan, Androcur, Colchicine Tiofarma
- Cariban is a food supplement: this is not true: pyridoxine is Vitamin B6 but the other active ingredient is an antihistamine.The HPRA confirmed this is not the case in February 2022. In any case, certain types of food supplements are covered under the community drug schemes e.g.: high-dose folic acid.
In November 2022, the government announced that the cost of Cariban would be reimbursed from January 2023, and the HSE issued a circular with the details on the 3rd of January 2023.
However, this new process introduced a number of barriers to care, most crucially that Cariban is only reimbursable when (a) prescribed by a consultant and (b) accompanied by a specific, paper form filled in by the consultant and approved by the PCRS (see link above).
This is medically unnecessary, increases burden on hospitals, and also on patients - particularly public patients. Our full statement on this is here. It has also been criticised by the Irish Pharmaceutical Union as “difficult in practice and creates needless access inequalities”.
We have presented to the Oireachtas on this issue, and in February 2023 the Minister for Health announced a review into the process (which was then less than two months old). We have been told this review will require "several months" of data, and we are seeking further clarification from the Minister and the HSE.
As of 24 April 2023, 1,074 women have been approved for Cariban reimbursement, but we are concerned about patients' necessary treatment being delayed by the onerous HSE process, leading to increased illness and therefore burden on the maternity system.
How to get Cariban on the DPS/medical card
We have a short guide to the process here.
Selected press coverage of #HG2costly and Hyperemesis
Calls to reform access over drug to treat severe vomiting in pregnancy
Calls to reform access over pregnancy drug Cariban
Anti-Nausea Pregnancy Drug Still Not on the Drugs Payment Scheme Nor Covered by the Medical Card
Obstetrician: 'Some women with Hyperemesis are choosing not to continue with their pregnancy'
Overcomplicated: Reimbursement scheme for pregnancy drug criticised by pharmacists
HSE looking into whether 'special arrangement' possible for access to severe pregnancy sickness drug
Minister 'hopeful' positive outcome can be reached to help women with severe pregnancy sickness
Health Minister insists State won't reimburse cost of drug to treat severe pregnancy sickness
Group to investigate options for funding severe pregnancy sickness drug to make it more available
Hyperemesis: 'No rational whatsoever for needing consultant to prescribe drug'
How commmon is Hyperemesis in Ireland?
'Like Having a Hangover for Eight Months', goverment urged to pay for costly pregnancy medication
Hyperemesis: I wouldn’t be able to walk, talk, or work without Cariban
Government moves to reduce the cost of pregnancy medication
Viagra is on the medical card but Cariban cost me €3k
Consumer Watch: The Cost of Cariban
Cork mother of two calls on Health Minister to meet with Hyperemesis suffers as he considers funding Cariban.
The Opinion Line Podcast Extra
New mum who vomited 20 times a day gave up home due to cost of anti-nausea meds
Top medic: ‘If the state can pay for Viagra, it can pay for extreme pregnancy sickness drugs’
'It stole the joy of my pregnancy...'
State refunds Viagra costs but women must pay for severe pregnancy sickness drugs, Seanad told
How a crippling medical condition made it tough for me to enjoy being pregnant
Extreme pregnancy sickness: I couldn’t afford the medication and three years on, I’m still suffering the consequences
East Coast FM
We are grateful to Declan Meehan and The Morning Show for covering the campaign on several occasions.
How you can support #HG2costly