Answers to your questions about CGMs and insulin pumps: Online information session

You asked how long the delay will be and whether we could give a timeframe for when the proposal will go to the Pharmac Board.

At this point we can’t provide a definitive date for when a decision will be made. But can assure you we are working on it as fast as we can.

What we can say though is that we’re in the final stretch. We expect that this work will be completed in the coming months – and that we intend to take the proposal to the Board for a decision in 2024. 

Please know that this pause in the timeline is not a reset – we’re not going back to the starting blocks with our funding proposal. The team here is as committed as we have been throughout this process to getting these devices funded for you.

You asked whether we could progress the funding for CGMs now, and the insulin pumps later.

It’s not as simple as that, unfortunately.

The proposal is a result of a commercial process that allowed us to bring together a package of products, and we are unable to separate the individual devices to progress for funding separately. 

This type of commercial strategy is how we work to get the best medicines and devices we can from our fixed budget.

You asked about the make-up of the consumer panel we consulted with.

You wanted to know whether we talked to type 1 diabetics, endocrinologists, and paediatric endocrinologists.

You asked how we picked the people we talked to and whether type 1 diabetics using CGMs and insulin pumps were consulted.

We talked to many different people when working on the competitive process for CGMs, insulin pumps, and insulin pump consumables. 

The evaluation committee meetings included: 

• type 1 diabetics, some of who were already using CGMs and insulin pumps
• endocrinologists
• paediatric endocrinologists
• diabetes nurse specialists

These people were nominated by the New Zealand Society for the Study of Diabetes and Diabetes NZ. Members of our Diabetes Specialist Advisory Committee were also involved. 

Pharmac used information gathered during the evaluation meetings, alongside the Factors for Consideration, to select the preferred suppliers and products.

We’re continuing to discuss the proposal with people as we work through the next steps.

You asked about when the Pharmac Board meets.

Our Board holds regular scheduled meetings in February, March, May, June, July, September, October, and November. 

Occasionally, if there is an important item to be considered in the other months (January, April, August, and December), the Board will have an 'Out of Cycle' meeting. 

Information about our Board is available on our website, including who our Board members are and minutes from previous meetings. 

Our Board

You asked about the procurement process we followed when building the CGMs, insulin pumps, and insulin pump consumables proposal.

You asked about the other technology Pharmac considered when we were working on the proposal.

As a government entity, we must openly advertise procurement opportunities where there are several suppliers who may be able to participate.

We must make decisions that are fair, evidence-based, and that achieve the best health outcomes for New Zealanders within the budget available.

In mid-2023, we released a request for proposals (RFP). This is a formal request asking suppliers to propose how their products can achieve a specific outcome and meet budgets.

More about requests for proposals

We received bids from a number of suppliers in response to the Request for Proposals (RFP). Unfortunately, at this time we are unable to share the suppliers that bid in this RFP.

To assess these bids, we held three evaluation committee meetings, which included clinical experts, consumer representatives, and Pharmac staff. 

We then used the information we gathered during the evaluation meetings, alongside the Factors for Consideration, to select the preferred suppliers. 

You asked about how you will receive the CGMs and insulin pumps. 

You wanted to know whether you will need to:

• pay to see your doctor

• get a prescription every three months for CGMs

• pay a pharmacy surcharge

Under the proposal, you would need to get a prescription from a relevant health practitioner (this includes doctors, nurse practitioners, and registered nurse prescribers) to access CGMs. If you need an insulin pump, you would need to discuss this with your diabetes team at your local hospital.

Pharmac cannot pay for your appointment with a doctor or nurse, so please talk to your general practice about how much an appointment would cost. 

Once you’ve been approved for a CGM or insulin pump, you would be given a prescription that you can take to your local pharmacy.

A prescription would be required to get a funded CGM or insulin pump and insulin pump consumables – the same as other medicines. The prescription would be for three months’ supply. Currently all prescriptions are free, but from 1 July 2024 they will cost $5 for most people.

You asked whether people who are currently self-funding CGMs and, as a result have excellent HBA1C control, will be able to access funding for insulin pumps. 

People who already have good diabetes control while self-funding their CGMs and/or insulin pumps would not be disadvantaged under Pharmac’s proposal. 

The proposed criteria for insulin pumps don’t include specific HBA1c requirements or thresholds.

The proposed eligibility criteria for insulin pumps

You asked how many extra sensors are proposed

In the consultation, we indicated what the maximum number of funded sensors per year would be. This does provide some additional sensors (about 10%), which should be enough if there are any issues.

You asked about publicly funded health services for people who are on work visas or who are residents.

We’re not the right people to answer this question, but you can find information about publicly-funded health services on Health New Zealand's website.

Guide to eligibility for public health services – Health NZ(external link)

You asked whether the proposed CGMs and insulin pumps would be able to operate in an emergency – longer than 2-3 days. 

The insulin pumps we have proposed to fund either have a running time of 5-7 days on inbuilt rechargeable batteries (Tandem) or have replaceable AA batteries (Ypsopump).

To run the Automated Insulin Delivery system with the Ypsopump, a charged smartphone is required, however in an emergency it could still be operated manually as a stand-alone insulin pump.

The CGMs selected as part of the proposal have their own power supply and need to be replaced with a new CGM at the end of their life.

The National Emergency Management Agency (or NEMA)(external link) recommends that you have supplies, including any medicine and special items you need, for a minimum of three days, or a week or more if you can.

You asked about what feedback we received and from who. 

We received a significant amount of feedback – about 1,200 responses, including a petition with over 9,000 signatures. We’re very grateful for the feedback, which has come in from a variety of groups, including clinicians, individuals with type 1 diabetes, consumer groups, and suppliers.

Most of the feedback we got was supportive of the proposal. However, we also received feedback that raised issues related to product usability, the health impacts of changing insulin pumps, and the support needed to help with a change of insulin pump. We are working to understand and fully consider these issues.

As we’re still working on consolidating and understanding this feedback, we can't give much more information than this. But once a decision is made, we will release a summary of themes and our response to them.

You asked whether the Government’s Budget announcement in April would impact the proposal. 

The Budget announcement in April secured our fixed budget for the next four years. This included the amount for the estimated cost of the proposal to fund CGMs, insulin pumps, and insulin pump consumables that we consulted on.
 
Before we consult publicly on a proposal, we secure contracts with suppliers that are provisional on approval by the Pharmac Board.

We are in a space now where we will have to go back to suppliers, make any required amendments to the contracts, and work with them to make sure we are still working within our fixed budget. 

You asked whether there will be enough CGMs and insulin pumps available if the proposal is approved. 

The proposed suppliers have assured us there would be enough stock of CGMs, insulin pumps, and insulin pump consumables to meet the demand.

You asked about the training and support you would get if the proposal is approved.

We’re working on how training and support will be provided to you, and the health and disability system, if this proposal is approved. 

We are working with the proposed suppliers, the New Zealand Society of the Study of Diabetes, Diabetes NZ, Health New Zealand, GP organisations, and other members of the health and disability system to ensure the required support is available.

This will include information to help with the use and selection of CGMs and insulin pumps, and people who can offer further help.

We will provide more information about this once a decision has been made by the Pharmac Board.

You asked what CGMs and insulin pumps were proposed

Proposed CGMs

Proposed insulin pumps

What the eligibility criteria was for CGMs 

Proposed eligibility criteria for CGMs

Proposed eligibility criteria for CGMs that are compatible with insulin pumps

What the eligibility criteria was for insulin pumps

Proposed eligibility criteria for insulin pumps

How we established the eligibility criteria

We worked with our Diabetes Specialist Advisory Committee and the New Zealand Society for the Study of Diabetes (NZSSD) to establish the conditions that must be met before someone can qualify or access CGMs, insulin pumps or insulin pump consumables (eligibility criteria). 

You asked how "Type 1 Diabetics" was defined in the proposal.

In the proposal, people with Type 1 diabetes or pancreatogenic diabetes will be eligible for CGMs or insulin pumps. 

Pancreatogenic diabetes is defined as people with permanent neonatal diabetes (happens in the first 4 weeks of a child's life) or people with an insulin deficiency caused by cystic fibrosis or pancreatectomy (the surgical removal of all or part of the pancreas).

Some of the feedback we received during the consultation was related to who should be eligible for funded CGMs and insulin pumps. We will be asking for advice from our Diabetes Specialist Advisory Committee regarding the proposed eligibility criteria.

You asked whether you will be able to upgrade CGMs to newer versions as they become available.

Under the proposal, as new CGM technology becomes available, the suppliers could introduce it. As part of the provisional agreements with suppliers, this would be possible, but Pharmac would need to agree to it first.

You asked what to do if the proposed devices were to break.

Obviously, we hope that you don’t have any problems with your CGM and that everything works perfectly - but we know that sometimes the unexpected can happen.

When you’re given the CGM or insulin pump, you would also be provided with information about what to do if there are problems. 

So, if your CGM breaks you might need to go back to your pharmacy or get in touch with the supplier to organise a replacement. 

If you’re unsure, you would need to have a chat to your doctor, nurse, or pharmacist so that it’s clear what to do if your CGM isn’t working. 

We will provide more information about this once a decision has been made by the Pharmac Board.

You asked if you could have ‘fast-track’ access to CGMs or insulin pumps if you are already using them. 

It would be up to your doctor or nurse, or your hospital diabetes team, to determine who would be prioritised for a funded CGM or insulin pump, so please have a chat with them.

Keep in mind though that a lot of people will want to book appointments with their health practitioners the moment CGMs and insulin pumps are funded.

New Zealand’s health services – both GPs and clinical teams in hospitals – are really stretched so you might need to wait a little for an appointment. They’ll want to get these devices to you as quickly as possible, but it is going to require some patience from us all.

You asked if this proposal is approved by the Pharmac Board, whether you will still be able to access a funded blood glucose diagnostic test meter and testing strips.

Blood glucose diagnostic test meters and blood glucose diagnostic test strips are funded by Pharmac. 

These will continue to be funded if the proposal to fund CGMs, insulin pumps, and insulin pump consumables is approved. 

Pharmac is not planning to make any changes to the funding of blood glucose diagnostic test meters and blood glucose diagnostic test strips. 

Will these products continue to be available for purchase from suppliers without prescription as current? Or will these become 'prescription only' devices once funding is implemented?

If you’re not eligible for a funded CGM or insulin pump, you will still be able to buy these devices from the supplier directly should you wish to do so. You would not need a prescription to purchase these from suppliers.

You asked whether we will be measuring the longer-term impacts on this proposed funding decision on people with type 1 diabetics.

We would be interested in the outcomes of an investigation into the long-term benefits of the proposed funding and implementation of CGMs, insulin pumps, and insulin pump consumables for people with type 1 diabetes. We would consider supporting this where appropriate and possible.