Tapering strip developers to take on health insurers

Many patients who use psychiatric drugs like antidepressants, antipsychotics, sleeping pills and sedatives struggle to taper off their medication use, despite this being recommended by medical professionals. Cinderella Therapeutics Foundation and Maastricht University's User Research Center (URC) jointly developed so-called tapering strips to slowly and safely taper off drug doses. Some health insurers, however, are refusing to cover the cost of these strips in their basic health insurance policies, believing they don't comply with the criteria for rational pharmacotherapy. Cinderella and URC launched a campaign to put an end to the unnecessary use of medications resulting from the stance taken by health insurers.

Dr Peter Groot (Cinderella and URC) and Professor Jim van Os (URC) sent a letter to Zilveren Kruis to address the insurance company's stance on the rationality of tapering strips. This letter explains why tapering strips do indeed comply with the criteria for rational pharmacotherapy. In a gesture of goodwill, Zilveren Kruis has agreed to insure the tapering strips temporarily, until the issue can be discussed in more detail in June. The same applies to Achmea and its subsidiaries. CZ has also informed several patients that they will not cover the cost of these strips. To prevent CZ and other health insurers from continuing to engage their clients in this discussion, Cinderella and URC decided to publish their letter to Zilveren Kruis online to inform all parties of the results (i.e. health insurers, patients, doctors, psychiatrists, psychologists, patient organisations, healthcare institutions and journalists).

Continued use is cheaper
The prolonged use of antidepressants is considered a major problem and, despite various efforts, no real solution has been found. Furthermore, scientific research studies have yielded minimal results at best. The number people who use antidepressants has remained relatively stable over the years, as has the number of complaints about these drugs. Very few people manage to successfully wean themselves from these medications, which is why tapering strips were developed. Despite their success, however, health insurers are refusing to cover tapering strips in their plans as it's cheaper to cover the costs of medication. Thanks in part to the highly successful preference policy in the Netherlands, which dictates that only the cheapest version of a medication is covered by insurance, many drugs have become so cheap that almost anything that could help someone live without drugs is more expensive than continuing with the drugs in the first place. Prescribing pills is almost always the cheapest solution, at least in the short term. In the long term, however, it could lead to the unnecessary use of medications. The potential results of this unnecessary use are illustrated in an e-mail Cinderella received from a patient about her struggle to reduce her dose: 'The strips are really helping me reduce my intake, but had I known I'd have to pay for them myself I might have stuck to the medication. They're a lot cheaper, unfortunately.'

Sample letter for patients
'We hope that publishing our letter to Zilveren Kruis will prompt all health insurers to talk to us instead of their clients, who are essentially powerless in this situation,' says Groot. 'Pending the results, we advise clients to lodge a written complaint against their insurance companies if they refuse to cover these costs.' The User Research Center has published a downloadable sample letter on its website.

Cinderella and the User Research Center hope to create more clarity about including tapering strips in basic insurance policies.

Cinderella Therapeutics & User Research Center
Cinderella Therapeutics is a non-profit foundation that works exclusively with volunteers with the aim of making 'stepchild' drugs available to patients at an affordable price. Maastricht University's User Research Center gives experts the opportunity to conduct their own research. Dr Peter C. Groot works as a volunteer at Cinderella and is affiliated with the User Research Center as a researcher and expert. His work for the tapering strips is funded by the Fonds Psychische Gezondheid (a foundation promoting awareness and treatment of psychological issues). Prof. Jim van Os is a Psychiatry professor at Maastricht University and is also affiliated with the User Research Center.

Cinderella, URC, Dr Groot and Professor Van Os have no financial interest in the development or provision of tapering strips. Cinderella does not develop these strips in house, but contacted pharmacist Paul Harder from the Regenboogapotheek, who was willing to do so.


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