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Polish doctors fear penalties for prescribing ADHD treatment medications

Polish doctors fear penalties for prescribing ADHD treatment medications

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Weronika Paliczka,
19.06.2024 16:30

Patients diagnosed with ADHD face a significant problem. The National Health Fund is imposing penalties on doctors who prescribe drugs containing methylphenidate if pharmacotherapy is not accompanied by psychotherapy.

The situation for patients in need of psychotherapists in Poland is deplorable. Finding a therapist financed by the National Health Fund (Polish: Narodowy Fundusz Zdrowia, NFZ) who is not fully booked until 2027 is akin to winning the lottery. The schedules of private therapists are no better, with many overbooked for the next few years.

Poles seeking crisis support can only hope for a miracle or turn to Crisis Intervention Centres, which operate in every province. However, this is still just a drop in the ocean.

Is NFZ going to war with doctors?

The National Health Fund has announced inspections and penalties for doctors who prescribe methylphenidate-based medication, a substance used to treat ADHD, to patients who are not simultaneously undergoing psychotherapy. The NHS expects doctors to certify that the patient is receiving psychotherapy; otherwise, it imposes penalties.

In an interview with Gazeta Wyborcza, the mother of a child diagnosed with ADHD and autism said, "I recently found out from the psychiatrist we have been seeing for a long time that, for my son to be prescribed medication, I have to provide a certificate that he is undergoing psychotherapy. To be precise, that he is not just under the care of a psychologist or therapist, but specifically in psychotherapy. This is what the NFZ requires for prescribing this medication to children."

The woman emphasised that her son is in therapy, but the cost is high—ranging from PLN 750 to PLN 1,000, depending on the number of sessions per month. She expressed concern for children whose parents cannot afford private psychotherapy.

"I worry about what will happen to children who can't access psychotherapy because their parents can't afford it or because they lack access to specialists. For me, even in Warsaw, it was difficult to find a psychotherapist and get into the queue. I know that the waiting time is up to two years at the outpatient clinic. How can the NFZ make the reimbursement of a medication contingent on the use of a therapy that is essentially unavailable through the NFZ?" she asks.

Doctors concerned about inspections

The boy's mother reports that doctors in Silesia and Małopolska are particularly vocal about the inspections: "Not only is it difficult for children to see a psychiatrist or psychologist, but now access to medication is being restricted. The National Health Service is washing its hands of the matter, while the social costs are borne by children, parents, and schools, which also face significant challenges with ADHD children. Compensating for attention deficits is often crucial for a child to learn effectively."

NFZ spokesperson explains the controversy

Currently, two medications containing methylphenidate hydrochloride are available on the Polish pharmaceutical market for the treatment of under-18s: Concerta and Medikinet. These drugs are state-reimbursed, with carers only paying a small portion of the cost. The National Health Service constantly monitors prescriptions for both medications, as they are potent psychotropic substances that can cause serious problems if used incorrectly.

Andrzej Troszyński, a spokesman for the National Health Fund, has taken an interest in the matter. In an interview with Gazeta Wyborcza, he stated: "The product is only reimbursed for attention deficit hyperactivity disorder as part of a comprehensive treatment plan, which includes psychotherapy, for children over the age of six. This means that when issuing the administrative decision to include the product in the reimbursement scheme, the Minister of Health specified that its use is only justified if pharmacotherapy complements psychotherapy. In other words, pharmacotherapy is merely a component of the therapeutic process for this patient population and cannot function independently of the other components. If prescriptions are made without the psychotherapy element, the treatment loses its comprehensiveness and cannot be considered legitimate within the reimbursement guidelines."

The NFZ spokesperson also added that the treatment of ADHD should be carried out by psychiatrists or paediatricians experienced in treating the disorder.

Source: Gazeta Wyborcza

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