Questions and answers
Changes to funded diabetes management products
Answers to your questions
(Note: click on questions to jump to answer and back to top of page.)
- What is PHARMAC changing?
- When are the changes occurring?
- What will be the impact of the decisions?
- What changes did PHARMAC make to the proposals as a result of consultation?
- What if I use the Freestyle Optium (Optium Xceed) to test for ketones?
- How does PHARMAC use savings?
- What has PHARMAC funded for diabetes management in the past few years?
- What should I do if I need a new meter between now and 1 September 2012?
- Can I choose to stay with my existing meter?
- I have a lot of test strips in reserve, can I continue to use them with my existing meter until they run out?
- Does this mean there will be only one brand of blood glucose test strip and meter?
About the meters
- Will health professionals be able to access information from the new meters?
- Can the CareSens meters interact with the Animas pumps that are being funded?
- Will new meters become available over time?
- Are the CareSens meters new?
- Will patients be able to choose their own meters?
- How accurate are the blood glucose meters?
- Have the new meters had any user/field testing done on them?
- What is the temperature range for the meters and test strips?
- How will this decision affect those who have bought their pumps that interface with a meter?
- Will patients have to pay a co-payment when they change meters?
- Who is able to receive a subsidised CareSens meter?
- How can I find out more about the CareSens test meters and strips and contact the supplier?
- Why has my CareSens meter given a different blood glucose reading than my current meter, even though I tested at the same time?
Funding of insulin pumps
- How will I know if I am eligible for a funded insulin pump?
- What will be the impact of the insulin pumps funding decision?
- Will I be able to keep using my current insulin pump?
- I already use my own insulin pump, will I be eligible for one of the newly funded devices?
- Will training be provided to help me use an insulin pump?
- What if a funded pump isn’t suitable for me?
- How many people currently have a funded insulin pump?
- Will metal cannulas be funded?
About the agreements
- Why has PHARMAC entered into these new contracts?
- How does PHARMAC manage stock issues?
- Did PHARMAC consider packaging insulin pumps and blood glucose testing meters together?
Implementing the decisions
- How does PHARMAC intend to roll out the decision?
- What are the costs of switching patients from one brand to another?
- Will material about the new products be available in languages other than English?
- When will implementation of the decisions begin?
- What implementation activities are planned?
- What will be the role of nurses, pharmacists and doctors during implementation?
- Will health professionals be reimbursed for the time training patients?
1. What is PHARMAC changing?
Blood glucose meters and test strips
Three meters and two types of blood glucose testing strips are being funded from the CareSens range, supplied by Pharmaco NZ Ltd. Read the Notification of decision relating to blood glucose meters and test strips.
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 Question 4 below).
The Animas 2020 insulin pump will be funded for patients with insulin-dependent diabetes. Read the Notification of decision to fund insulin pumps and consumables. PHARMAC estimates up to 1,000 people will qualify for funded pump under the Special Authority access criteria in the next five years. This is the first time insulin pumps have been funded consistently on a nationwide basis.
In December 2012 PHARMAC announced funding for a second brand of insulin pumps and consumables.
Other changes to diabetes products
PHARMAC also recently agreed to provide full funding for some other diabetes products:
- Insulin aspart (NovoMix 30 FlexPen) – a new intermediate-acting insulin that is 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 through a subsidy increase.
- Ketone urinalysis sticks (Ketostix) – these will continue to be fully funded. SensoCard blood glucose test strips will also continue to be funded (SensoCard blood glucose test meters are currently funded by the New Zealand Foundation for the Blind(external link)).
The funding criteria for insulin pumps were developed following advice from PTAC (the Pharmacology and Therapeutics Advisory Committee) and the expert Diabetes Subcommittee. A panel of clinicians will review all Special Authority funding applications.
2. When are the changes occurring?
- 1 September 2012: Animas insulin pump funded.
- 1 September 2012: PHARMAC begins funding CareSens N and CareSens N POP meters. Funding for other meters and strips (FreeStyle Lite, On Call Advanced, Freestyle Optium, Accu-Chek Performa) continues. Patients can begin transition to CareSens brand meters.
- 1 December 2012: PHARMAC ceases funding meters other than the CareSens brand (funding for other test strips continues).
- 1 March 2013: PHARMAC ceases funding the FreeStyle Lite, On Call Advanced, Freestyle Optium, and Accu-Chek Performa brands of blood glucose testing strips with some exceptions (see Question 4 below). Sole supply of CareSens meters and strips begins.
Transition to the new meters began 1 September 2012. PHARMAC can answer questions through its free phone number 0800 66 00 50 (9am - 5pm Monday to Friday) or by email at firstname.lastname@example.org.
Pharmaco also provides a dedicated free phone number 0800 GLUCOSE (0800 458 2673), and information on its website, www.caresens.co.nz(external link), to answer questions about the meters and test strips.
3. What will be the impact of the decisions?
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 a co-payment for any prescription item). Should patients wish to continue using their existing meters (that aren’t funded), they will have to pay the total cost for test strips themselves.
Changing to the CareSens brand of meters and test strips will free up $10 million per year that PHARMAC will be able to use to fund other healthcare.
4. 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-Chek 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 there were no major changes to it. Some people wanted to continue using pumps they had purchased, so we are making this possible for people using the Accu-Chek Combo pump (see above).
In December 2012 PHARMAC also announced the listing of a second insulin pump and its consumables, to provide greater clinical choice to patients and clinicians.
5. What if I use the Freestyle Optium (Optium Xceed) to test for ketones?
You will continue to receive funded test strips for this meter. Patients who were using a Freestyle Optium (Optium Xceed) 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 .
6. How does PHARMAC use savings?
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 has 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 management products decision, this type of investment would be much more difficult for New Zealand to afford.
In 2010/11, we were able to fund three new-generation cancer drugs at an annual cost of approximately $10 million (bortezomib for multiple myeloma, erlotinib for lung cancer, sunitinib for kidney cancer). See PHARMAC’s Annual Report 2010/11 for an overview of investments in new medicines and products that PHARMAC made using savings made that year.
7. 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 the 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), and
- Funded insulin pumps (from September 2012).
8. What should I do if I need a new meter between now and 1 September 2012?
Before 1 September 2012, patients have a choice of using any of the currently funded meters, including the CareSens II. The CareSens II will continue to be supported throughout the transition and new funding agreement. Patients can then upgrade to a further meter from the CareSens range after 1 September 2012 if they wish.
9. Can I choose to stay with my existing meter?
Patients can choose to stay with 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 Question 4 above). The cost of unsubsidised products that patients may wish to purchase privately is set by the supplier of those products.
At current pricing, costs are estimated to be around $35-$50 or more for unsubsidised products. If you do choose to use unsubsidised products, we suggest you shop around as the price can vary from pharmacy to pharmacy.
10. 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.
11. Does this mean there will be only one brand of blood glucose test strip and meter?
Yes. PHARMAC is funding three models of meter in the CareSens range - CareSens N, CareSens II and CareSens N POP, and two types of blood glucose test strips – CareSens (which is used with the CareSens II meter) and CareSens N (which is used with the CareSens N and CareSens N POP meters).
Patients currently using other brands of meters can privately purchase the strips for those meters and new patients will be able to privately purchase other brands of meters and strips if their preferred brand is not funded.
About the meters
12. 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.
13. 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 which is compatible with the Diasend software that supports the Animas pumps.
Patients will be able to take readings from their CareSens meters and use them to manually adjust insulin dosages delivered by the Animas pump.
People who have purchased the Accu-Chek Combo pump will be able to continue using the Accu-Chek Performa Combo meter. PHARMAC intends to reach an acceptable commercial agreement with the supplier for PHARMAC to fund the test strips for this meter for the next five years.
14. Will new meters become available over time?
PHARMAC’s contract with Pharmaco includes the provision for new technology meters to be introduced as they become available.
15. Are the CareSens meters new?
The CareSens II meter is currently funded. CareSens N and CareSens N POP are new meters that have not been used in New Zealand previously. Both of these meters include features and functions to meet the range of needs of patients.
16. Will patients be able to choose their own meters?
Yes. As part of implementation, patients will be able to choose the meter that best suits their needs. This will include discussions with health professionals to determine which funded meter is right for patients. In addition, the funded meters are of different sizes so patients will be able to select which one best suits them.
17. How accurate are the blood glucose meters?
PHARMAC has had accuracy and precision testing carried out on all three meters that it has decided to fund. The diabetes test meter evaluation service was set up and funded by PHARMAC in response to an accuracy issue with Accu-Chek Performa meters in 2007 that resulted in a nation-wide recall. It is the advice of the Diabetes Subcommittee of PTAC (our main clinical advisory committee) that any new meter should pass accuracy and precision tests prior to being listed by PHARMAC.
Testing shows that all three meters meet the standards of accuracy and precision required to enable listing on the Pharmaceutical Schedule.
You can read the reports on the meters:
18. Have the new meters had any user/field testing done on them?
Like all the meters that are currently funded, the CareSens meters have been tested for accuracy and precision (see Question 16 above). None of the currently funded meters were required to be field tested before funding.
As well as accuracy and precision testing, PHARMAC discussed with Diabetes New Zealand about having some field testing performed on the meters in advance of any decision. For various reasons this was unable to be progressed. We continue to be willing to work with patient groups to develop information that will help patients choose a meter to suit their needs.
19. What is the temperature range for the meters and test strips?
The operating temperature range for the CareSens meters and strips is 10 to 40 degrees.
All blood glucose meters and strips have different operating temperature ranges. The operating temperature of the CareSens meters and strips is comparable to others available internationally.
The Freestyle Optium meter has a similar operating temperature range to the CareSens meters (10 to 50 degrees). A significant number of patients use this meter in Canterbury (33%) and Otago (30%), which demonstrates that meters with this kind of operating temperature range can be successfully operated in colder areas of the country. The CareSens products have also been tested in many countries with colder climates than New Zealand, including Russia and the UK.
20. How will this decision affect those who have bought their own pumps that interface with a meter?
Patients using the Accu-Chek combo pump and Accu-Chek Performa Combo meter prior to 1 June 2012 will be able to continue doing so. PHARMAC intends to reach an acceptable commercial agreement with the supplier for PHARMAC to fund the test strips for the Accu-Chek Performa Combo meter for up to five years.
21. Will patients have to pay a co-payment when they change meters?
No. Patients eligible for a subsidised meter will not need to pay a co-payment for funded blood glucose meters between 1 September 2012 and 28 February 2013. There will still be a co-payment for funded test strips as there is currently.
22. Who is able to receive a subsidised CareSens meter?
Following clinical advice, the following groups of people are able to access a subsidised CareSens meter:
- those who manage their diabetes using sulphonylurea and/or insulin therapy,
- women who have gestational diabetes,
- those who are on home TPN at risk of hypoglycaemia or hyperglycaemia, and
- those who have a genetic or an acquired disorder of glucose homeostasis, excluding type 1 or type 2 diabetes and metabolic syndrome.
People who manage their diabetes with diet & exercise, or metformin therapy alone, will still not be entitled to a subsidised CareSens meter through their pharmacy. However, CareSens II meters are being made available for these people through their GP or practice nurse. They will continue to be subsidised for 50 test strips per prescription, and may wish to purchase one of the other meters themselves. This may be a good opportunity for people to discuss with their health professional whether frequent testing continues to be useful for their clinical circumstances.
23. How can I find out about the CareSens test meters and strips and contact the supplier?
You can also download our 2012 comparison of blood glucose test meters.
24. Why has my CareSens meter given a different blood glucose reading than my current meter, even though I tested at the same time?
It is possible that two blood glucose meters will give different results, even if they are the same model from the same manufacturer. This does not mean either of the meters is wrong.
A hand held testing device can never be as accurate as a laboratory test. The worldwide standard for blood glucose meters is that they are accurate to within plus or minus 20% of what a laboratory test would show.
For example, if your lab result is 8.0 mmol/L, a clinically accurate reading would range from 6.4 mmol/L on the low side to 9.6 mmol/L on the high side.
If you are concerned that a meter is not testing accurately, you can check it with control solution available at your pharmacy. Or you can take the meter next time you have a blood sample taken. Test with your meter at the same time as the lab sample is taken, and compare the results.
If you are unsure what the readings of your new meter mean for your diabetes management, discuss your concerns with your health professional.
NOTE: It is important to wash your hands to remove all residue, sugar, hand cream etc. before testing so that you can get the most accurate result.
Funding of insulin pumps
25. How will I know if I am eligible for a funded insulin pump?
You should talk to your doctor about whether you are eligible for funded access to an insulin pump. The funding rules (Special Authority criteria) are outlined in our Notification of decision to fund insulin pumps and consumables.
A panel of expert clinicians will assess each Special Authority funding application to determine whether the patients meet the Special Authority criteria.
26. What will be the impact of the insulin pumps funding decision?
Prior to this decision, access to a funded insulin pump depended on where you lived as decisions were made by individual DHBs (District Health Boards) applying their own criteria and this led to unequal access across the country. The decision means that all people in New Zealand who meet the funding criteria, and whose clinical circumstances mean they require access to a funded insulin pump, can receive one.
We expect that up to 1,000 people nationally will meet the criteria, and that spending on insulin pumps and consumables will reach about $4 million per year.
27. Will I be able to keep using my current insulin pump?
This depends on whether the supplier decides to keep its consumable products available in New Zealand. PHARMAC has no control over this. In some cases the consumables for the Animas 2020 pump may be compatible with your pump.
PHARMAC will continue funding the testing strips for the Accu-Chek Performa Combo meter used with the Accu-Chek Combo insulin pump for some people for up to five years (see Question 4 above).
28. I already use my own insulin pump. Will I be eligible for one of the newly funded devices?
It’s possible that not everyone who is currently self-funding an insulin pump will meet the access criteria for a funded insulin pump. For that reason, it’s best to talk to your health professional about whether you meet the funded access criteria. The funding criteria are outlined in our Notification of decision to fund insulin pumps and consumables.
29. Will training be provided to help me use an insulin pump?
Yes. We understand that patients starting on insulin pumps require significant training to achieve optimum results from their insulin pump. One of the criteria for funded access is that patients must receive training to ensure they can safely use their insulin pump. New Zealand Medical and Scientific (NZMS)(external link), the provider of the Animas 2020 insulin pumps, is also contracted to provide technical support on the use of its insulin pump.
30. What if the funded pump isn’t suitable for me?
We recognise that the Animas 2020 insulin pump may not suit everyone’s clinical needs. For that reason, PHARMAC has asked for proposals from suppliers with the aim that a second pump be funded. We expect this process to be concluded by the end of 2012.
31. How many people currently have a funded insulin pump?
We understand that there are around 200-300 people whose insulin pump use is supported in some way by DHBs. Some of these people will be contributing to the cost of either the pump or the consumables. With the PHARMAC decision, the full cost of pumps and consumables will be covered.
32. Will metal cannulas be funded?
Yes. Metal cannulas for insulin pumps were part of the initial proposal for funding this product and have been included for funding in the final decision. The following metal cannula products will be available funded from 1 September 2012:
- Contact-D insulin pump infusion set, 6 mm metal cannula, straight insertion, 60 cm grey line: 10 x needles, 10 x lines
- Contact-D insulin pump infusion set, 8 mm metal cannula, straight insertion, 60 cm grey line: 10 x needles, 10 x lines
- Contact-D insulin pump infusion set, 8 mm metal cannula, straight insertion, 110 cm grey line: 10 x needles, 10 x lines.
About the agreements
33. Why has PHARMAC entered into these new contracts?
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 New Zealanders when funding medicines and products within a fixed budget.
The recent diabetes management product decisions are the result of a commercial process run in 2011, when all suppliers of blood glucose meters, insulin pumps and other diabetes management products were invited to bid for supply. The 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.
PHARMAC currently subsidises approximately $22 million worth of diabetes test strips per year and approximately $33 million worth of diabetes medicines. 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 of funding each year that PHARMAC is reinvesting in other pharmaceuticals, for example the Animas insulin pumps.
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.
34. How does PHARMAC manage stock issues?
PHARMAC's agreements with suppliers often includes a requirement for suppliers to notify PHARMAC if stock falls below an agreed level. For the test strips and meters, PHARMAC has gone further than usual 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 for costs arising from out of stocks.
35. 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 and 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 competitive process has been issued for funding a second insulin pump to provide greater clinical choice.
Implementing the decisions
36. 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 key support from health professionals. PHARMAC and the supplier, Pharmaco, will also provide significant support for 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.
37. 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 operational cost of approximately $1 million that will be met by DHBs, PHARMAC and Pharmaco. This will be significantly less than the expected savings to the pharmaceutical budget of about $10 million per year.
Patients changing to CareSens funded test strips and meters should not expect to pay any more than they currently are. The costs of unfunded products that patients may wish to purchase privately would be determined by the supplier of those products.
38. 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
- Cook Island Maori
Go to the Pharmaco website(external link) for further information.
39. When will implementation of the decisions begin?
PHARMAC has already begun discussions with diabetes support groups and will shortly begin training programmes for health professionals. We aim to have health professionals familiar enough with the new meters to enable them to provide support to patients once funding begins on 1 September 2012.
40. What implementation activities are planned?
PHARMAC is planning a range of activities to support the change with the aim to make sure that any person who needs to manage their blood glucose has lots of options for how they can learn to use the meter. Some of the activities include:
- online training module for nurses, pharmacists and doctors to learn how to use the new meters
- face-to-face training of health professionals in learning how to use the new meters
- provision of e-waste facilities so that people are able to dispose of their current meter in an environmentally safe way
- provision of online and printed resources, and freephone telephone support for consumers to learn how to use the new meters, and
- a nationwide series of events for consumers and health professionals to gain advice and support on using the new meters.
Most of these activities will be available before 1 September 2012 when the new meters become subsidised by PHARMAC, and will be available throughout the transition period and beyond. Other activities, such as the nationwide series of events, will be rolled-out on a region-by-region basis to help manage the change.
The supplier, Pharmaco, will also provide support to patients on technical issues around the use of the meters and testing strips.
41. What will be the role of nurses, pharmacists and doctors during implementation?
We expect that the usual activities of health professionals will continue during implementation, including providing support to people with diabetes on the appropriate use of meters and test strips. Implementation activities will be aimed at providing appropriate support for health professionals to minimise any extra workload, as well as providing a number of mechanisms for patients to receive support in using a new meter.
Health professionals will be able to 'refer' people who require extra training in the use of a meter to events that will be held in their area.
42. Will health professionals be reimbursed for their time training patients?
Pharmacists will, for the first time, be able to claim for the cost of funded blood glucose meters they provide to patients. To recognise the time pharmacists are expected to take helping patients adjust to the change, they will be paid a brand switch payment on meters between 1 September 2012 and 28 February 2013.
PHARMAC is investigating ways to minimise any extra burden on health professionals for training patients in the use of a new meter. Details of this extra support will be provided once the activities and approach have been finalised.
Last updated: 25 June 2018