Justice chancellor: Regulation on ADHD drug accessibility unconstitutional

Medikinet (methylphenidate) is a prescription drug commonly prescribed in Estonia for the treatment of ADHD.
Medikinet (methylphenidate) is a prescription drug commonly prescribed in Estonia for the treatment of ADHD. Source: Aili Vahtla/ERR

The Chancellor of Justice has proposed bringing into conformity with the Constitution a regulation issued by the minister of social affairs according to which prescription drugs used to treat ADHD currently aren't available at a discount to insured adults in Estonia who were diagnosed with ADHD after turning 20.

According to the Estonian Health Insurance Fund's (EHIF) regulation-approved list of drugs, medications used to treat ADHD can only be prescribed at a discount to adults who were diagnosed with ADHD before they turned 20.

Chancellor of Justice Ülle Madise noted that no substantive justification exists for such a distinction.

"This disorder being diagnosed before one turns 20 is dependent on circumstances not within the control of a child or young person," Madise wrote in her letter. "A child or young person doesn't often independently end up seeing a psychiatrist. ADHD was previously considered a disorder that children grow out of. It is likewise known that girls and women are frequently diagnosed [with ADHD] later than boys and men. Even the diagnosis process itself is made more difficult when ADHD symptoms are interpreted to be part of some other disorder. Treatment may be necessary regardless of when one received a diagnosis."

Currently, ADHD adults who were not diagnosed before turning 20 have to pay for their prescription medications in full. This means that they are not eligible for a typical 75- or 90-percent discount otherwise applied to ADHD drugs. Because of the high cost, for some, this means having to go without.

"Leaving ADHD untreated in turn results in significant costs for the healthcare, social and education systems as well as for society as a whole," the justice chancellor underscored. "For the individual, going untreated can mean struggling to cope at work, financial difficulties, substance abuse issues, sleep disorders and chronic fatigue, an increased risk of getting into an accident, including deadly accidents, as well as a high risk of suicide."

Madise found that treating different people with the same condition differently solely based on when their condition was diagnosed conflicts with the principles of solidarity-based health insurance and equal treatment.

"As a result of such different treatment, those who cannot afford their medications without a discount may end up going untreated," she explained, adding that, according to §12 of the Constitution, it is prohibited to treat people in similar situations unequally without a reasonable and appropriate reason for doing so.

The chancellor of justice has requested the regulation be amended to bring it into compliance with the Constitution of Estonia as well as the Health Insurance Act.

She has set a deadline of August 8 for the ministry to respond and outline how this issue will be resolved.


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Editor: Aili Vahtla

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