Doctors and diabetic patients are facing delays of weeks or months waiting for the Health Insurance Organisation (HIO) to approve injectable diabetes medications, with some patients forced to interrupt treatment, remain on doses their doctors have deemed unsuitable, or wait indefinitely before beginning therapy at all.
Doctors who spoke to Phileleftheros described a system in which approval requests — whether for first-time prescriptions, dosage changes or treatment continuation — are left unanswered for extended periods, creating what they said are serious risks to patient health.
Three months for a dosage change
In one case, a doctor submitted a request to change a diabetic patient’s dosage in early January. The HIO did not respond until early April — three months later — and only after the doctor lodged a formal complaint with the organisation, warning that the patient’s health was already at risk.
A separate doctor told Phileleftheros that he has been waiting nearly four weeks for responses to six requests relating to his diabetic patients. Two concern starting treatment, two involve dosage changes and two relate to continuation of existing therapy. All six were submitted on the same day and none has received a response.
The same doctor highlighted what he described as a striking inconsistency in the HIO’s approval timelines. “It is noteworthy that through the various and different procedures followed, medications or other items that are far more expensive — for example for cholesterol — are approved within 24 hours, insulin pumps are approved within one week, but injectable diabetes medications, which are far cheaper, require at least one month for a response,” he said.
Bureaucratic burden on chronic condition renewals
A third doctor raised a separate concern about the renewal process for chronic condition medications. Treatments such as anticoagulants go through automatic pre-approval, but when the initial six-month prescription expires, doctors are required to repeat the entire questionnaire process, providing the same answers, in order to renew the patient’s therapy.
The process, the doctor said, requires printing the form, signing it manually and then sending it electronically to the HIO, as “there is no provision for an electronic signature or even another method of notification to be accepted.”
Inconsistent prescribing rules
Doctors also pointed to inconsistencies in the rules governing who can prescribe injectable diabetes medications. For some drugs in this category, a personal doctor can issue the prescription directly. For others in the same category, the personal doctor is required to refer the patient to an endocrinologist or specialist pathologist within GHS — even if the personal doctor holds a pathology specialty.
Patients’ federation raises alarm
Konstantinos Tsioutis, President of the Scientific Advisory Committee of the Federation of Patient Associations of Cyprus (CyFPA/OSAK), told Phileleftheros that more than 15 cases have reached the organisation in recent weeks from doctors and patients — mainly diabetics — who are in long-term waiting for approval of their requests.
“We understand the workload, we understand that possibly, with the changes made over the past year regarding medications generally, the HIO may not yet be properly staffed. However, these cannot serve as justification for patients to wait and not begin their treatment, or to be forced to interrupt their treatment because approval for its continuation is delayed,” Tsioutis said.
As a federation, he added, “we have raised the issue before the HIO and we expect that whatever changes are deemed necessary will be advanced to facilitate doctors and their patients. Every patient has the inalienable right to receive the treatment they need, when they need it.”
HIO acknowledges problem
Phileleftheros contacted the HIO with the complaints raised by doctors and patients, focusing primarily on injectable diabetes medications. The organisation acknowledged the problem, saying that specific rules have been identified which appear to be causing largely unnecessary delays. A review of approval procedures for medications subject to HIO pre-approval is also under way, the organisation said.