Health bill: Pharmac’s financing of glucose monitoring is a big step – with a few pitfalls

Every New Zealander with the most severe form of diabetes will soon be able to measure their blood sugar levels almost immediately. It is considered the most important change in the treatment of diabetes
New Zealand since the advent of insulin 100 years ago.

New Zealanders with type 1 diabetes no longer have to prick their fingers several times a day to maintain their blood sugar levels.

Pharmac said last year it was investigating funding continuous glucose monitors (CGMs) for all 18,000 New Zealanders who have the condition.

The bulk purchasing agency has now outlined its financing plans for the devices. Here are the details, including the pros and cons.

The life-saving device

A CGM is a wearable sensor that measures a person’s blood sugar levels and transmits this information to a smartphone.

It can be connected to an insulin pump that automatically injects the wearer to stabilize blood sugar levels (also called a hybrid closed loop).

Patients with type 1 diabetes cannot produce their own insulin, and if their blood sugar levels rise or fall significantly, it can have serious and potentially fatal consequences.

Many patients in New Zealand do this by pricking their finger and testing a blood sample several times a day, then injecting themselves with insulin.

CGMs are essentially an external pancreas and are considered a much 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 that is worn on the belt or placed in a pocket.

Pharmac already finances an insulin pump and its accessories, but not the monitors. That makes New Zealand an outlier among OECD countries.

Pharmacy’s proposal

Pharmac said last year it would finance the devices for type 1 diabetics and asked suppliers for bids.

That process is now complete 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 financed options for people who don’t have smartphones or can’t afford them.

The products will be free to all 18,000 patients with type 1 diabetes. Diabetes New Zealand says this is important because some countries limit funding to under-18s.

Under the plan, patients could receive the specified CGMs starting in July.

Pharmac is now seeking feedback on the proposals. The consultation period closes on Friday.

The answer

Diabetes New Zealand has been campaigning for funded glucose meters for six years and said Pharmac’s proposals would be transformational.

“They are actually life-changing,” says CEO Heather Verry. “This is a huge relief and is being viewed with great excitement by people with type one.”

They are not only life-changing for the user, but also for parents and caregivers, who can remotely monitor their child’s blood sugar levels and no longer have to wake up regularly to check or treat their children.

Karen Reed from Rotorua was diagnosed with type 1 diabetes when she was ten. She performed the finger prick test eight to ten times a day and injected herself with insulin six times a day and after meals.

Although she received funding for an insulin pump in 2012, she still paid out of pocket for her monitor and ongoing costs and still had to perform some of her treatment manually.

Under Pharmac’s plan, she would be able to automatically control her blood sugar levels, she said.

“It will allow me to move on with my life.”

Funding reversed

As part of the financing proposals, Pharmac will stop financing Medtronic-branded insulin pumps.

Between 1,500 and 2,000 people using the MiniMed pump will have to switch to one of the new brands.

This causes significant anxiety for some people who rely on the device. CGMs had such a profound 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 diabetics use the technology or transition to new devices within a year.

Marika Harvey, a trainee nurse with type 1 diabetes, said the rollback of funding for the Medtronic brand has left her and many others in a “precarious situation”. She had tried other brands and found they were not as accurate or responsive.

“With the other versions I went from hypo to hyper several times a day, and that is tiring.”

For that reason, she will not switch to the funded devices, and will pay for and pump her CGM out of her own pocket if necessary – about $10,000 if she needs a new device and $50 per week in operating costs.

A petition has been launched to maintain funding for the Medtronic pumps, which has been signed by 7,400 people so far.

Not set in stone

Adrienne Martin, acting director of pharmaceuticals, stressed that consultations are ongoing and no decisions have been made at this time.

Martin said Pharmac recognized that changing brands can be difficult. The twelve-month time frame was based on clinical advice from the advisory committee.

“Our advisors told us that some people may be able to transition quickly and without difficulty, while others may find it difficult (and) may need a transition period of up to two years.”

About 10 percent of patients will be able to access various products through the ‘exceptional circumstances’ rule.

Pharmac could not reveal detailed reasons why it chose these brands, but said it planned to choose no more than two suppliers of pumps and CGMs within available funding.

What about type 2 diabetes?

Pharmac said it was not considering type 2 patients in the bidding process, but welcomed funding applications in this area.

“We understand that there is growing evidence to support the use of these technologies to help people with type 2 diabetes. Māori, Indian and Pacific Islander people experience worse health outcomes from type 2 diabetes than other population groups. These technologies can help reduce inequalities in type 2 diabetes.”

Isaac Davison is an Auckland-based reporter covering health issues. He joined the Herald in 2008 and has previously covered environmental, political and social issues.