Which medicines for depression and anxiety are affected by the reimbursement change?

As of 5 March 2012, the conditions will change for getting reimbursement for a number of medicinal products for depression and anxiety (antidepressants and anxiolytics). These medicines will become eligible for "general conditional reimbursement", i.e. the medicines are reimbursable if the patient meets the conditions for getting reimbursement for the medicine and the GP has written/indicated "tilskud" (reimbursement) on the prescription.

Below is a list of medicinal products which are eligible for conditional reimbursement in future. For each medicine, we have outlined their traditional use and indicated the type of patient that can get reimbursement for them after 5 March 2012.

Agomelatine (Valdoxan, N06AX22)

It is used for treatment of depression. The clinical experience is sparse, but this product can be attempted if other antidepressants have caused uncomfortable adverse reactions. It is expensive compared to some of the medicines that are recommended as first-line treatment for depression.

In future, reimbursement is only paid on condition that it is used for depression:

• where treatment with an antidepressant with general unconditional reimbursement has proven inadequate or is not tolerated, or
• in exceptional circumstances where a switch for successfully treated patients to an antidepressant with general unconditional reimbursement is linked with a great risk of relapse, as assessed by a doctor based on an overall clinical assessment of the patient's mental health.

Buspirone (Buspiron "Actavis", N05BE01)

It is approved for treatment of anxiety and agitation, and it may be an option for treatment of generalised anxiety when other medicinal products (SSRIs) fail to work. It is expensive compared to some of the medicines that are recommended as first-line treatment for generalised anxiety.

In future, reimbursement is only paid on condition that it is used for generalised anxiety:

• where treatment with an anxiolytic with general unconditional reimbursement has proven inadequate or is not tolerated, or
• in exceptional circumstances where a switch for successfully treated patients to an anxiolytic with general unconditional reimbursement is linked with a great risk of relapse, as assessed by a doctor based on an overall clinical assessment of the patient's mental health.

Duloxetine (e.g. Cymbalta, N06AX21)

It is used for treatment of depression, generalised anxiety and neuropathic pain. It is expensive compared to some of the medicines that are recommended as first-line treatment for these disorders.

In future, reimbursement is only paid on condition that it is used for depression or generalised anxiety:

• where treatment with an antidepressant/anxiolytic with general unconditional reimbursement has proven inadequate or is not tolerated, or
• in exceptional circumstances where a switch for successfully treated patients to an antidepressant/anxiolytic with general unconditional reimbursement is linked with a great risk of relapse, as assessed by a doctor based on an overall clinical assessment of the patient's mental health.

Escitalopram (e.g. Cipralex, N06AB10)

It is an SSRI - the so-called happy pills. It is used for treatment of depression and various anxiety disorders. It is expensive compared to the least expensive SSRI products and it is recommended equally.

In future, reimbursement is only paid on condition that it is used for depression or anxiety:

• where treatment with an antidepressant/anxiolytic with general unconditional reimbursement has proven inadequate or is not tolerated, or
• in exceptional circumstances where a switch for successfully treated patients to an antidepressant/anxiolytic with general unconditional reimbursement is linked with a great risk of relapse, as assessed by a doctor based on an overall clinical assessment of the patient's mental health.

Fluvoxamine (Fevarin, N06AB08)

It is an SSRI - the so-called happy pills. It is used to a very limited extent for treatment of depression and various anxiety disorders. It is expensive compared to the least expensive SSRIs and, among other issues, it causes more adverse reactions.

In future, reimbursement is only paid on condition that it is used for depression or anxiety:

• where treatment with an antidepressant/anxiolytic with general unconditional reimbursement has proven inadequate or is not tolerated, or
• in exceptional circumstances where a switch for successfully treated patients to an antidepressant/anxiolytic with general unconditional reimbursement is linked with a great risk of relapse, as assessed by a doctor based on an overall clinical assessment of the patient's mental health.

Imipramine (Imipramin "DAK", N06AA02)

It is a tricyclic antidepressant (TCA), and it is used for treatment of depression and nocturnal enuresis (bedwetting). It is more expensive than the other medicines in the group of tricyclic antidepressants.

In future, reimbursement is only paid on condition that it is used for nocturnal enuresis and depression:

In case of depression, reimbursement is conditional and it is only paid if used:

• where treatment with an antidepressant with general unconditional reimbursement has proven inadequate or is not tolerated, or
• in exceptional circumstances where a switch for successfully treated patients to an antidepressant with general unconditional reimbursement is linked with a great risk of relapse, as assessed by a doctor based on an overall clinical assessment of the patient's mental health.

These conditions do not apply to nocturnal enuresis. However, from now on the prescriber must write "tilskud" (reimbursement) on the prescription.

Isocarboxazid (Marplan, N06AF01)

It can be used for treatment of depression and it is considered to be specialist treatment. It is expensive compared to some of the medicines that are recommended as first-line treatment for depression.

In future, reimbursement is only paid on condition that it is used for depression:

• where treatment with an antidepressant with general unconditional reimbursement has proven inadequate or is not tolerated, or
• in exceptional circumstances where a switch for successfully treated patients to an antidepressant with general unconditional reimbursement is linked with a great risk of relapse, as assessed by a doctor based on an overall clinical assessment of the patient's mental health.

Pregabalin (Lyrica, N03AX16)

It is used for treatment of generalised anxiety, epilepsy and neuropathic pain. It is expensive compared to some of the medicines that are recommended as first-line treatment for generalised anxiety.

In future, reimbursement is only paid on condition that it is used for epilepsy and generalised anxiety.

In case of generalised anxiety, reimbursement is conditional and it is only paid if used:

• where treatment with an anxiolytic with general unconditional reimbursement has proven inadequate or is not tolerated, or
• in exceptional circumstances where a switch for successfully treated patients to an anxiolytic with general unconditional reimbursement is linked with a great risk of relapse, as assessed by a doctor based on an overall clinical assessment of the patient's mental health.

These conditions do not apply to epilepsy. If it is to be used for epilepsy, the prescriber should follow the current practice and simply write "tilskud" (reimbursement) on the prescription.

Quetiapine, prolonged-release tablets (e.g. Seroquel Prolong, N05AH04)

It is mainly used for treatment of schizophrenia and bipolar disorder (a manic-depressive disorder), but it can also be used for supplementary treatment of depression. It is expensive compared to some of the medicines that are recommended as first-line treatment for depression.

In future, reimbursement is only paid on condition that it is used for schizophrenia, bipolar disorder, other psychoses and supplementary treatment of depression:

In case of supplementary treatment of depression, reimbursement is conditional and it is only paid if used:

• where supplementary treatment with an antidepressant with general unconditional reimbursement has proven inadequate or is not tolerated, or
• in exceptional circumstances where a switch for successfully treated patients to an antidepressant with general unconditional reimbursement is linked with a great risk of relapse, as assessed by a doctor based on an overall clinical assessment of the patient's mental health.

These conditions do not apply to schizophrenia, bipolar disorder and other psychoses. However, from now on the prescriber must write "tilskud" (reimbursement) on the prescription.

Reboxetine (Edronax, N06AX18)

It can be used for treatment of depression, but it only has a limited effect. It is expensive compared to some of the medicines that are recommended as first-line treatment for depression.

In future, reimbursement is only paid on condition that it is used for depression:

• where treatment with an antidepressant with general unconditional reimbursement has proven inadequate or is not tolerated, or
• in exceptional circumstances where a switch for successfully treated patients to an antidepressant with general unconditional reimbursement is linked with a great risk of relapse, as assessed by a doctor based on an overall clinical assessment of the patient's mental health.

Other reimbursement changes

Paroxetine, sertraline, escitalopram and mirtazapine in liquid pharmaceutical forms, e.g. as oral solutions, will in future be eligible for conditional reimbursement for depression or anxiety, where treatment with an oral antidepressant/anxiolytic in solid pharmaceutical form with general unconditional reimbursement is not possible.

The reimbursement for acepromazine (Plegicil, N05AA04) is removed. As is the reimbursement for diazepam and clomipramine for injection.

Overview of current and future reimbursement status

We have drawn up an overview of current and future reimbursement status of all of these medicines (Excel file, opens in a new window).