OIA response: funding for blood glucose monitors and test strips

Request for information regarding our decision to fund blood glucose monitoring systems.

24 November 2020

Dear [name and contact details withheld]

REQUEST FOR INFORMATION

Thank you for your request dated 27 October 2020 under the Official Information Act 1982 (OIA) for information relating to blood glucose monitors. In your email, you wrote:

I'm interested in finding out what Pharmac is doing with regard to considering funding of blood glucose monitoring systems. Is there any consideration being given to the benefits of fully funding a system like the Freestyle Libre or Dexcom G6? Alternately is Pharmac considering funding individual diabetics to a specified amount equal to what it would cost to fund caresense test strips and allow each person to decide for themself which method to use?

With that last concept in mind could you please also provide me with some official information.

How much does Pharmac pay in total for blood glucose monitoring systems for individuals each year? Does Pharmac hold information estimating how much test strips cost per person for people who are testing four times a day

Are there any systems other than Caresense test strips that Pharmac is funding?

Please find our response to your questions below.

Please note that PHARMAC approaches its assessment of requests for information under the OIA on the basis that, once released, the information becomes publicly available - in other words once we release the information to you it becomes available to any other party in that exact form (whether by you distributing it to others or by virtue of us receiving the same request from a different third party). 

PHARMAC currently has two (2) active funding applications for blood glucose monitors:

  1. Medtronic continuous glucose monitoring systems - Guardian 3 and Guardian Connect; and
  2. FreeStyle Libre flash glucose monitoring system

Please refer to the PHARMAC Application Tracker(external link) to view the status and public information of these applications, including links to related clinical advice meeting records. The Application Tracker can be found on our website: www.pharmac.govt.nz(external link) > top right corner: Application Tracker.

Anyone can make a funding application to PHARMAC. You can be a supplier, patient or health professional.

PHARMAC also has an Exceptional Circumstances Framework(external link) (“Framework”) which can be used to consider funding for individual patients whose circumstances fall outside the Pharmaceutical Schedule (“Schedule”) funding process and are considered exceptional in comparison to the general patient population. The Framework includes funding via the Named Patient Pharmaceutical Assessment(external link) (“NPPA”) Policy.

PHARMAC uses the NPPA process to consider whether to fund a treatment for an individual patient whose clinical circumstances are exceptional. Anyone can prepare a NPPA application, but a prescriber must be named as the applicant.

PHARMAC’s role within the New Zealand health system is to make decisions on which medicines and medical devices (pharmaceuticals) are funded in order to get the best health outcomes from within the available funding. The Schedule does not allow patients to be given funding to a specific amount; funding can only be provided through subsidy of specific pharmaceuticals.

How much does Pharmac pay in total for blood glucose monitoring systems for individuals each year?

For financial year ending 30 June 2020, PHARMAC has provided funding for blood glucose and blood ketone diagnostic pharmaceuticals (including test strips, test meters, lancets, etc) to the gross amount of $13,814,420.50.

PHARMAC has also approved patients with exceptional circumstances to access funded blood glucose monitors (and/or compatible sensors, etc) via the NPPA process. As we need additional time to collate and review this funding information, we will provide the 2019/20 gross funding amount to you as soon as possible and without undue delay.

Does Pharmac hold information estimating how much test strips cost per person for people who are testing four times a day

The Schedule list prices for funded blood glucose test strips are listed below and can be used to estimate individual patient costs depending on use. Based on the unit cost of $0.21 per CareSens N or PRO test strip ($10.56 divided by 50 test strips), the cost of 4 test strips per day is approximately $0.84, or $308.35 for one year (365 days).

Test strip

Price

Unit size

CareSens N

$10.56

50 test strips OP*

CareSens PRO

$10.56

50 test strips OP*

SensoCard

$26.20

50 test strips OP*

*OP = “Original Pack”

Are there any systems other than Caresense test strips that Pharmac is funding?

PHARMAC funds several diabetes management pharmaceuticals for people with diabetes to use within the community. PHARMAC funds CareSens N and CareSens PRO blood glucose test strips, SensoCard blood glucose test strips (for patients who are visually impaired), CareSens N, CareSens N POP and CareSens N Premier blood glucose diagnostic test meters, the CareSens Dual blood glucose and blood ketone diagnostic test meter; and KetoSens blood ketone diagnostic test strips.

Please refer to the online Schedule for full information of subsidies available for diabetes management pharmaceuticals(external link): www.pharmac.govt.nz(external link) > Pharmaceutical Schedule > Community Schedule > Search the Online Schedule > Alimentary Tract and Metabolism > Diabetes Management

We trust that this information answers your queries. We are making our information more freely available, so we will now publish selected OIA responses (excluding personal details) on our website.  Please get in touch with us if you have any questions about this.

Yours sincerely

Rachel Read
Manager, Policy and Government Services