Funding changes improve access to diabetes management
Media release
8
August 2012
Funding changes improve
access to diabetes management products
Funding changes to diabetes management products will improve the availability of medicines and devices for patients, provide greater security of supply and provide ongoing improvements in technology.
PHARMAC today announced:
• An annual investment of approximately $4 million to fund the Animas 2020 insulin pump and consumables supplied by NZ Medical & Scientific – the first time insulin pumps have been funded on a consistent nationwide basis;
• Funding for three blood glucose meters (including two new meters) and two testing strips from the CareSens range of products (supplied by Pharmaco NZ Ltd).
Funding of insulin pumps and the changes to funding for blood glucose meters and testing strips will be phased in over six months, beginning 1 September 2012. People don’t need to take any action until then. PHARMAC will support the changes with a comprehensive nationwide meter swap and education campaign involving pharmacists, clinicians and community and consumer groups.
PHARMAC Chief Executive Steffan Crausaz says the changes increase the funded options for people with diabetes, release funding and include safeguards for patients.
“These decisions enhance access to diabetes management products, release funds that can be reinvested in other medicines, and give us confidence of ongoing supply at affordable prices,” says Steffan Crausaz. “Our contract for blood glucose testing strips and meters gives patients access to modern high-spec meters, provides the opportunity for future technology upgrades, and gives us greater security of supply. It will also release $10 million a year that we are reinvesting in other medical devices and medicines.
“We have listened and responded to what we heard during consultation. As a result of people’s comments, we are funding a new higher-spec meter rather than an earlier model, and giving some patients the ability to continue using their existing meters and insulin pumps. We have sought further assurances from Pharmaco NZ Ltd, and in our contract we require them to maintain a minimum four months’ supply of test strips, which will minimise the likelihood of an out of stock occurring.”
Currently funded products will still be funded until the end of the year, with funding for strips other than the CareSens brand continuing until 1 March next year.
“Funding insulin pumps on a consistent nationwide basis is a significant step forward for diabetes management in New Zealand. It adds to other steps we have taken recently including funding a new intermediate-acting insulin (insulin aspart), and continuing full funding for glucagen hypokits. PHARMAC has carefully reviewed diabetes management products over the last three years making significant investments in six newly funded products and widening access to five others.
“We will be
supporting the brand change for meters and strips with a
comprehensive nationwide programme, so that health
professionals and people with diabetes receive the right
training and fully understand how to use the newly funded
meters.”
Changes
following consultation
Steffan Crausaz says PHARMAC made a number of changes to the insulin pumps and blood glucose meters and strips proposals in response to people’s consultation responses. The most significant changes from the proposal are:
• The introduction of a higher-tech meter, called CareSens N POP. The N POP meter includes increased memory, backlighting for night-time use, averages and other advanced functions sought by consumers in consultation.
• Patients who were using an Accu-Chek Performa Combo meter with an Accu-Check Combo insulin pump (prior to 1 June 2012) will be eligible for funded Accu-chek test strips. PHARMAC intends to maintain funding for those patients for the next five years, and intends to reach an acceptable commercial agreement with the supplier.
• Patients
who were using a Freestyle Optium as their only meter for
both blood glucose and ketone testing (prior to 1 June 2012)
will be eligible for continued funding of the Optium blood
glucose test strip. PHARMAC intends to maintain funding for
those patients for the next five years and intends to reach
an acceptable commercial agreement with the
supplier.
Blood glucose
meters and test strips
PHARMAC will fund three
CareSens meters: CareSens II, CareSens N and CareSens N POP,
and their related testing strips from 1 September 2012.
Steffan Crausaz says this provides a choice of three meters
for people with diabetes.
Funding for other brands of meters and strips will be phased out over six months from 1 September, with some exceptions (users of Accu-Check Combo insulin pump and Freestyle Optium meters).
The contract is flexible and allows for new technology to be introduced as it becomes available.
“The contract provides greater security of supply, over and above previous arrangements. For example, Pharmaco will be required to maintain a minimum of four months’ stock of testing strips to minimise the risk of out of stocks occurring,” Steffan Crausaz says.
“Pharmaco is a New Zealand company committed to the New Zealand market, and our experience is that it is a reliable supplier of pharmaceutical products. Our discussions and contract arrangements give us confidence that Pharmaco will be able to supply and fully support these meters and strips in New Zealand.”
Insulin pumps
Until now, patient access to funded insulin pumps has varied across different District Health Boards (DHBs). This has led to uneven and inequitable supply from one region to another. From September, nationally-consistent criteria will apply for the first time.
PHARMAC estimates funding the Animas 2020 insulin pumps and consumables will cost approximately $4 million per year. In the next five years up to 1000 people are expected to meet the Special Authority access criteria, which will be administered by a panel of clinical experts.
The agreement with NZ Medical & Scientific allows for a further brand of insulin pump from another supplier to be funded. Steffan Crausaz says that, alongside today’s announcement, PHARMAC is releasing a Request for Proposals for the supply of a second funded pump option to provide more clinical choice to patients and their clinicians. Decisions are likely to be made before the end of this year.
Information
and support
Steffan Crausaz says PHARMAC recognises that any change can be difficult for patients and clinicians. Because of this, PHARMAC will be working closely with diabetes support groups, pharmacists and clinicians to ensure high quality information and support is available during the meters and strips brand change.
The PHARMAC website www.pharmac.govt.nz has been updated to provide further detailed information about these announcements and the support available. While no action is required until September, people can also call the PHARMAC support line on 0800 66 00 50.
Information about the
Pharmaco blood glucose meters and test strips is available
at www.caresens.co.nz.
Steffan Crausaz
says PHARMAC will now move to advise people of details on
the training, meter swap and education programme that will
accompany the funding changes. Details will be provided to
health professionals, patients and patient groups before the
funding changes begin from 1
September.
ENDS
Questions & Answers
1. What decisions have been made
in relation to diabetes management
products?
Three meters and two types of blood
glucose testing strips are being funded from the CareSens
range, supplied by Pharmaco NZ Ltd. The meters are:
•
CareSens II
• CareSens N
•
CareSens N POP
The decision will mean the
CareSens meters and strips are the only ones funded by
PHARMAC for a three year period, although some patients will
be eligible for continued funding of their existing strips
and meters (see Q6 below).
The Animas
2020 insulin pump will be funded for patients with
insulin-dependent diabetes. In the next five years PHARMAC
estimates up to 1000 people will qualify for funded pumps
under the Special Authority access criteria. This is the
first time insulin pumps have been funded consistently on a
nationwide basis.
PHARMAC has also recently agreed to
provide full funding for some other diabetes
products:
• Insulin aspart – a new
intermediate-acting insulin that has been funded for the
first time. This increases the range of insulins now
fully funded by PHARMAC
• Glucagen hypokit
– this will continue to be fully funded
•
Ketone urinalysis sticks (Ketostix) – these will continue
to be fully funded.
2. What are the
timings of the changes?
• 1 September 2012:
Animas insulin pumps will be funded
• 1
September 2012: PHARMAC begins funding CareSens N
and CareSens POP N meters. Funding for the currently funded
meters and strips (FreeStyle Lite, On Call Advanced, Optium
Xceed, Accu-Chek Performa) continues. Patients can begin
transition to CareSens meters
• 1
December 2012: PHARMAC ceases funding meters other
than CareSens brand (funding for other test strips
continues)
• 1 March 2013:
PHARMAC ceases funding the FreeStyle Lite, On Call Advanced,
Optium Xceed, Accu-Chek Performa brands blood glucose
testing strips. Sole supply of CareSens meters and strips
begins
Until 1 September 2012, people should
continue to use their current meters and strips, and have
their prescriptions filled as usual.
3. Where can I find more
information about the changes?
PHARMAC has
published extensive information at www.pharmac.govt.nz which
includes:
• A media release summarising the
changes
• Summaries of the issues raised in
consultation
• The PHARMAC Board decision
paper
• An outline of PHARMAC’s
implementation plan
It is important to know that
patients do not need to do anything at this stage. The main
changes do not start taking effect until 1 September 2012
and there will be a six month transition phase. However,
PHARMAC can answer questions through its free phone number
0800 66 00 50 (9am - 5pm Monday to Friday).
Pharmaco also
provides a dedicated free phone number 0800 GLUCOSE (0800
458 2673), and information on its website www.caresens.co.nz.
4.
How will the changes affect patients?
The
decisions will reduce costs and provide better treatment
options for people with diabetes. Insulin pumps will be
funded for the first time on a consistent nationwide basis.
Funding insulin aspart increases the range and choice for
patients using insulin. Also, the decision has been made to
continue fully funding Glucagen Hypokits because we
recognise the importance of this product to enable people to
manage blood glucose levels.
For patients choosing to
switch to the funded strips and meters there will be no
additional costs (other than the usual co-payment for any
prescription item). PHARMAC expects the number of people
eligible for funded meters and strips will grow. Should
patients wish to continuing using meters that aren’t
funded, they will have to pay the total cost themselves.
5. How does PHARMAC intend to roll out the
decision?
PHARMAC is working with stakeholders
on a detailed implementation plan, This will be completed
and communicated to health professionals and other
stakeholders before 1 September 2012. Our vision is for the
plan to be led by patients or patient groups with
significant input from health professionals. PHARMAC and the
supplier, Pharmaco, will also support the implementation.
The plan will include details such as how patients can
pick up a new meter, dispose of their old one in an
environmentally safe manner, training for patients and
health professionals on how to use the new meters, and
evidence-based guidance on blood glucose testing.
A
summary of PHARMAC’s implementation plan is available on
the PHARMAC website www.pharmac.govt.nz
6.
What changes did PHARMAC make to the proposals as a result
of consultation?
We received nearly 3000
responses to our insulin pumps and test strips and meters
consultation with a broad range of issues raised. A number
of changes have been made to the proposals following
consultation, with the most significant being:
•
The introduction of a higher-tech meter, called CareSens N
POP. The N POP meter includes increased memory, backlighting
for night-time use, averages and other advanced functions
sought by consumers in consultation.
• Patients
who were using an Accu-Chek Performa Combo meter with an
Accu-Check Combo insulin pump (prior to 1 June 2012) will be
eligible for funded Accu-chek test strips. PHARMAC intends
to maintain funding for those patients for the next five
years, and intends to reach an acceptable commercial
agreement with the supplier.
• Patients
who were using a Freestyle Optium as their only meter for
both blood glucose and ketone testing (prior to 1 June 2012)
will be eligible for continued funding of the Optium blood
glucose test strip. PHARMAC intends to maintain funding for
those patients for the next five years and intends to reach
an acceptable commercial agreement with the supplier.
The
insulin pumps proposal was welcomed by most submitters, so
no major changes to what was proposed occurred. An RFP for
funding of a second insulin pump, to provide greater
clinical choice to patients and their clinicians, has been
released and decisions are anticipated by year
end.
7. What should I do if I need a new
meter between now and 1 September?
Before 1
September 2012 patients have a choice of using any of the
currently funded meters, including the CareSens II (which
will continue to be supported throughout the transition and
new funding arrangements). Patients who are using the
CareSens II can upgrade to a different meter from the
CareSens range after 1 September 2012 if they wish.
8. Can I choose to keep using my existing
meter?
Patients can choose to keep using their
existing meters, however after 1 March 2013 only CareSens
meters and blood glucose test strip products will be
subsidised by PHARMAC (with some exceptions – see
Q6 above). The cost of unsubsidised products that
patients wish to purchase privately is set by the supplier
of those products.
At current pricing, costs are
estimated to be around $35-$50+ per 50 strips for
unsubsidised test strips.
9. I have a lot of
test strips in reserve, can I continue to use them with my
existing meter until they run out?
Yes, but
please check their expiry date before you use
them.
10. Will health professionals be able to
access information from the new meters?
Yes.
Readings from the CareSens meters can be downloaded into an
online software package that can be accessed via secure
passwords by patients and health professionals. This will
enable health professionals to keep track of and easily
access the records of their patients.
11. Can
the CareSens meters interact with the Animas pumps that are
being funded?
Information from the CareSens
meters can be downloaded to an online software package. This
information is compatible with the Diasend software that
supports the Animas pumps.
Patients will be able to take
readings from their meters and use them to manually adjust
insulin dosages delivered by the Animas pump.
People who
have purchased the Accu-Chek Combo pump and use the
Accu-Chek Performa Combo meter to remotely control their
insulin dose will be able to continue using this device as
PHARMAC will fund the testing strips for the next five
years, subject to an acceptable agreement being reached with
the supplier.
12. Will the functionality of
the meters improve over time?
PHARMAC’s
contract with Pharmaco includes a provision allowing for new
technology meters to be introduced as they become available.
13. Why has PHARMAC entered into these new
arrangements?
PHARMAC wants to ensure that it
is able to offer New Zealanders the best health outcomes
possible by improving access to medicines and other health
technologies, across the spectrum of diseases and
conditions. Our objective is to maximise health outcomes for
all New Zealanders when funding medicines and products
within a fixed budget.
The recent diabetes product
decisions are designed to widen the pool of patients that
have funded access to high-quality blood glucose meters,
test strips and insulin pumps and related consumables. Where
we can provide ongoing access to existing technologies with
good quality and usability, at a lower cost, it is something
that we will always look at. Indeed this is one of the
central purposes for PHARMAC.
The new test strips and
meters agreement includes significant price reductions while
maintaining patients’ access to high quality meters and
strips. This frees up $10 million funding each year that
PHARMAC will reinvest in other pharmaceuticals.
Insulin
pumps have not previously been funded consistently across
the country, so the decision will ensure an end to the
`postcode prescribing’ of insulin pumps where access
depended on where people lived.
Funding insulin aspart
provides enhanced treatment options for patients who inject
insulin.
14. How does PHARMAC manage stock
issues under the sole supply agreement?
Sole
supply is an effective strategy for obtaining competitive
prices and ensuring continued supply of off-patent medicines
and devices. PHARMAC's sole supply agreements include
requirements for suppliers to notify PHARMAC if stock falls
below an agreed level. For the test strips and meters,
PHARMAC has gone further than it has in the past and
required Pharmaco to maintain no less than four months’
supply of test strips in the country. This offers protection
for patients against the chance of the strips going out of
stock. Supplier companies are liable to PHARMAC and DHBs for
costs arising from any out of stocks.
15. How
does PHARMAC use savings it makes?
PHARMAC
regularly looks across the range of pharmaceutical products
to see whether available funding can be used more
efficiently. In this case, significant funds of $10 million
every year have been released to invest in other health
initiatives.
In 2010/11 PHARMAC was able to fund 39 new
medicines and widen access to 43 more. Without savings
transactions such as the diabetes strips decision, this type
of investment would be much more difficult for New Zealand
to afford.
See PHARMAC’s Annual Report for 2010/11
for an overview of investments in new medicines and products
that PHARMAC made using savings made that year.
16. What has PHARMAC funded for diabetes
management in the past few years?
PHARMAC has
carefully reviewed diabetes management products over the
last three years and has made significant new investments
(six newly funded products and widened access to
five):
• Funded blood ketone test strips for
insulin-dependent diabetes mellitus (July 2009) and widened
access (August 2010)
• Widened access to
pioglitazone for Type 2 diabetes (July 2009) and to lancets
(October 2009)
• Funded rapid-acting insulin
glulisine (August 2010)
• Widened access to
long-acting insulin glargine for Type 1 diabetes; and to
oral hypoglycaemic agent acarbose for Type 2 diabetes
(August 2010)
• Funded Accu-Check Ketur-Test
urinalysis strips and mid-acting insulin, insulin aspart.
Maintained full funding for an injectable treatment for
severe hypoglycaemia, glucagon hydrochloride, (June
2012)
• Funded insulin pumps (September
2012).
17. What are the costs of switching
patients from one brand to another?
We expect
the training, education, and the implementation of these
changes to have a total one-off cost of approximately $1
million. This will be significantly less than the savings
expected of about $10 million per year.
18.
Did PHARMAC consider packaging insulin pumps and blood
glucose testing meters together?
All suppliers
had the opportunity to submit proposals, including proposals
for both insulin pumps and glucose testing strips & meters.
When we assessed the proposals we received, the best value
was in keeping the pumps and meters separate. The pumps and
meters are from different suppliers, so were subject to
separate consultations. A further RFP has been issued for
funding of a second insulin pump to provide greater clinical
choice to patients and clinicians.
19. Will
material about the new products be available in languages
other than English?
Quick Guides for the
CareSens range of meters will be available in
• Te Reo
Maori
• Samoan
• Tongan
• Chinese
•
Vietnamese
• Cambodian
• Hindi
•
Punjabi
• Arabic
• Korean
• Cook Island
Maori
• Tokelauan
• Nuiean
Go to the Pharmaco
website for further updates.
ENDS