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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 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
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.

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 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
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
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.

© Scoop Media

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