Big funding change for diabetics
Pharmac covering glucose monitors is ‘life-changing’ step, with a few catches
New Zealanders with type one diabetes will no longer have to prick their finger multiple times a day to stay on top of their blood sugar levels.
Pharmac said last year it was looking at funding continuous glucose monitors (CGMs) for all of the 18,000 New Zealanders who have the condition.
The bulk-buying agency has now outlined its funding plans for the devices. Here are the details, including the upsides and downsides.
The life-saving device
A continuous glucose monitor is a wearable sensor which measures a person’s blood sugar levels and relays the information to a smartphone.
It can be connected to an insulin pump which automatically injects the wearer to stabilise their blood sugar (known as a hybrid closed-loop).
Type one diabetes patients cannot produce their own insulin and if their blood sugar levels rise or fall significantly it can have severe and potentially fatal consequences.
Many patients in New Zealand manage this by pricking their finger and testing the blood sample several times a day, then injecting themselves with insulin.
CGMs are effectively an external pancreas and are considered a far simpler method of treatment. They are slightly larger than a $2 coin and are worn on the stomach or arm, and can be connected to a small pump which is worn on the belt or placed in a pocket.
Pharmac already funds an insulin pump and its accessories but does not fund the monitors. That makes New Zealand an outlier in OECD countries.
Pharmac’s proposal
Pharmac said last year that it will begin funding the devices for type one diabetics and asked for bids from suppliers.
That process has now been completed and the agency has chosen several products to fund, including the monitors, insulin pumps and pump accessories.
It has made provisional agreements with suppliers of the Dexcom, Libre and Tandem brands. Patients who were using the MiniMed pump will have to switch to one of the funded brands. There will be funded options for people who do not have or cannot afford smartphones.
The products will be free for all 18,000 patients with type one diabetes. Diabetes New Zealand says that is significant because some countries limit funding to under-18s.
Under the plan, patients would be able to get the specified CGMs from July.
Pharmac is now seeking feedback on the proposals. The consultation period closes on Friday.
The response
Diabetes New Zealand has campaigned for funded glucose monitors for six years and said Pharmac’s proposals would be transformational.
“They are actually life-changing,” chief executive Heather Verry said.
“This is a massive relief and it is being viewed with great excitement by people with type one.”
They are not just life-changing for the user but for parents and caregivers, who can keep an eye on their child’s blood sugar levels remotely and no longer have to wake regularly to monitor or treat their kids.
Karen Reed, from Rotorua, was diagnosed with type one diabetes at 10. She used to do the finger-prick test eight to 10 times a day and inject herself with insulin six times a day and after meals.
While she was funded for an insulin pump in 2012, she still paid for her monitor and running costs out of her own pocket and still needed to do some of her treatment manually.
Under Pharmac’s plan she would be able to control her blood sugar automatically, she said.
“It will allow me to get on with living my life.”
Funding reversed
As part of the funding proposals, Pharmac will stop funding the insulin pumps under the Medtronic brand.
Between 1500 and 2000 people who use the MiniMed pump will have to shift to one of the new brands.
This is causing significant anxiety among some people who depend on the device. CGMs had such a significant impact on patients’ lives that Pharmac’s Diabetes Specialist Advisory Committee noted that they developed a “psychological affinity” for them.
There are also concerns about whether there are enough medical staff to help train diabetics to use the technology or transition to new devices within the one-year timeframe.
Marika Harvey, a trainee nurse who has type one diabetes, said reversing the funding for the Medtronic brand left her and many others in a “precarious situation”. She had trialled other brands and found they were not as accurate or responsive.
“With the other versions, I just went from hypo to hyper, several times a day, and that’s exhausting.”
For that reason, she will not switch to the funded devices, and if necessary will pay for her CGM and pump out of her own pocket — about $10,000 when she needs a new device and $50 a week in running costs.
A petition has been launched to maintain funding of the Medtronic pumps, and has so far been signed by 7400 people.
Not set in stone
Pharmac acting director of pharmaceuticals Adrienne Martin stressed that consultation was ongoing and no decisions had been made at this time. Martin said Pharmac recognised that changing brands may be difficult.
The 12-month timeframe was based on clinical advice from the advisory committee.
“Our advisers told us that some people may be able to transition quickly without difficulty and others may find it difficult [and] could need a transition period of up to two years.”
About 10 per cent of patients will be able to access different products through an “exceptional circumstances” rule.
Pharmac could not disclose detailed reasons for why it chose the brands, but said it had intended to choose no more than two suppliers of pumps and CGMs, within the funding available.
What about type two diabetes?
Pharmac said it did not consider type two patients in the bidding process, but welcomed funding applications in this area.
“We understand that there is emerging evidence for the use of these technologies to help people with type two diabetes. Mā ori, Indian, and Pacific people experience poorer health outcomes from type two diabetes than other populations. These technologies may help to reduce the inequities in type two diabetes.”