Absence of funding for pharmacotherapy for adults with ADHD in Poland
Authors: Daniel Pankowski, Kinga Wytrychiewicz-Pankowska
Journal: The Lancet Psychiatry (2024)

The Polish Ministry of Health reimburses the costs of pharmacotherapy, including drugs used to treat ADHD, for people younger than 18 years. Currently, reimbursement of medication costs for adults with ADHD diagnosed before age 18 years is being considered. Such actions deserve great praise, but the Polish Ministry of Health, based on opinions from clinical experts, is not considering any financial support for pharmacotherapy for people diagnosed with ADHD in adulthood. The Polish Ministry of Health claimed that there are many cases of overdiagnosis of ADHD, especially in adulthood, as shown by large increases in the consumption of active substances (such as methylphenidate or atomoxetine, on the basis of information from prescription fulfillment documents) but did not cite any evidence used to deny the financial support. Globally, despite increases in the use of medications for ADHD, consumption is still lower than would be expected from the global epidemiological prevalence of ADHD.1Chan AYL Ma TT Lau WCY et al.Attention-deficit/hyperactivity disorder medication consumption in 64 countries and regions from 2015 to 2019: a longitudinal study.EClinicalMedicine. 2023; 58101780Summary Full Text Full Text PDF Scopus (10) Google Scholar This discrepancy should encourage the search for potential barriers to treatment of ADHD. In our opinion, the increase in ADHD drug consumption is something positive, indicating that appropriate treatment is reaching those in need. Explaining this increase as overdiagnosis of ADHD seems unfair to patients. ADHD has high heritability of 70–80%;2Faraone SV Larsson H Genetics of attention deficit hyperactivity disorder.Mol Psychiatry. 2019; 24: 562-575Crossref PubMed Scopus (521) Google Scholar therefore, many children with ADHD will have a parent with the disorder. As ADHD in adults is often underdiagnosed, a child with ADHD might grow up with a parent who has undiagnosed ADHD, and most of the child's feelings and behaviours might be perceived as usual within the family. As a result, the family does not seek medical help for the child, and the diagnosis is not made until the individual seeks help during adulthood. Adults with ADHD have higher rates than the general population of educational underachievement, job loss, car accidents, divorce, anxiety, depression, antisocial behaviours, suicide, and premature death.3Faraone SV Banaschewski T Coghill D et al.The World Federation of ADHD International Consensus Statement: 208 evidence-based conclusions about the disorder.Neurosci Biobehav Rev. 2021; 128: 789-818Crossref PubMed Scopus (461) Google Scholar The implementation of pharmacotherapy in people with ADHD reduces substance misuse, criminality, injuries, vehicle accidents, and suicide-related events, and improves mental health. Protocols for using medications for adults with ADHD are well described in guidelines prepared by professional health-care associations.4Kooij JJS Bijlenga D Salerno L et al.Updated European Consensus Statement on diagnosis and treatment of adult ADHD.Eur Psychiatry. 2019; 56: 14-34Crossref PubMed Scopus (303) Google Scholar Because the Polish Ministry of Health did not provide any scientific sources supporting the decision not to reimburse the costs of drugs for people diagnosed with ADHD as adults, we fear that this decision was made based on opinion rather than scientific evidence. We believe that the denial of the medical diagnosis of ADHD by clinical experts appointed by the Polish Ministry of Health is a dangerous decision that could lead to additional stigmatisation of this group of patients, who already face stigmatisation in many areas of life. For adults with ADHD, receiving a diagnosis is often the beginning of a new, better life in which many of the difficulties they experience are finally explained and properly treated.5Attoe DE Climie EA Miss. Diagnosis: a systematic review of ADHD in adult women.J Atten Disord. 2023; 27: 645-657Crossref Scopus (8) Google Scholar The decision by the Polish Ministry of Health should be re-evaluated by the Agency for Health Technology Assessment and Tariff System after reviewing scientific evidence, given that the availability of drugs to treat ADHD is scandalously low (currently, methylphenidate is not available in Poland), and the price of treatment is a serious barrier to effective treatment for many people. Increasing the availability of treatment through reimbursement and increasing supplies in pharmacies could greatly improve the health and quality of life of people with ADHD, their families, and society. We declare no competing interests.