Federal CGM Funding

Saturday, April 1, 2017 - 14:00

From 1 April 2019 the Australian government has expanded subsidised access to continuous glucose monitoring (CGM) for eligible Australians with type 1 diabetes, specifically those with high clinical needs.

This decision reflects years of effort by members of the diabetes community. We congratulate everyone involved for their continued support.

Funding will apply to Medtronic CGM products used with a Medtronic Insulin Pump or standalone CGM with the new Guardian Connect system. Guardian Sensor 3 and associated transmitters will be listed on the NDSS from 1 April 2019.

The eligibility criteria for the Federal CGM Funding announced is available from the NDSS and listed below. There are 4 key segments who will benefit from this announcement.

  1. Children and young people aged under 21 years with type 1 diabetes. Click here for full criteria.
  2. People with type 1 diabetes aged 21 years or older who have valid concessional status and have a high clinical need. Click here for full criteria.
  3. Women with type 1 diabetes who are actively planning pregnancy, pregnant, or immediately post-pregnancy. Click here for full criteria.
  4. Children and young people under 21 years with conditions very similar to type 1 diabetes who require insulin. Click here for full criteria.

HOW YOU CAN BENEFIT FROM MEDTRONIC CGM  

CGM measures and indicates glucose levels continuously [24/7] to assist in monitoring. It can be used by type 1 diabetes patients who now get the power to avoid highs and lows at no cost to eligible patients.

There are two ways you can benefit from Medtronic CGM:

  • With an insulin pump.
  • Without an insulin pump. Guardian™ Connect CGM the world’s first Smart continuous glucose monitoring (CGM)^ system for people on insulin injections. With breakthrough tools to help outsmart the highs and lows of diabetes, the Guardian® Connect CGM gives you the power to focus more on your life—not on your levels.

This is important because people who are hypo unaware are six times more likely to have severe hypoglycaemia leading to seizures, coma and even death. Having hypos leads to more hypos and the increased risk of these severe events. 1

Children and young people aged under 21 years with type 1 diabetes

To be eligible for access to the CGM Initiative under this eligibility group, a child or young person must meet the criteria in one of the following categories:

Category (A) Category (B)

Children 10 years of age and younger with type 1 diabetes will be eligible for subsidised access to CGM if they meet ALL of the following criteria:

  • the child is expected to benefit clinically from the use of CGM; and
  • the family/carer has the willingness and capability to use CGM; and
  • the family/carer has the commitment to actively participate in a diabetes management plan that incorporates CGM.

NOTE: A child who has been accessing CGM products through the initiative will continue to have subsidised access after they turn 11. They will not need to be re-assessed under Category B.

Children and young people with type 1 diabetes aged from 11 years to less than 21 years will be eligible for subsidised access to CGM products if they meet ALL of the following criteria:

  • the person is expected to benefit clinically from the use of CGM; and
  • the person or family/carer has the willingness and capability to use CGM; and
  • the person or family/carer has the commitment to actively participate in a diabetes management plan which incorporates CGM.

AND they meet ONE OR MORE of the following criteria:

  • frequent significant hypoglycaemia—more than one episode a year of significant hypoglycaemia requiring external, third-party assistance; and/or
  • impaired awareness of hypoglycaemia; and/or
  • inability to recognise, or communicate about, symptoms of hypoglycaemia; and/or
  • significant fear of hypoglycaemia for the child/young person or a family member/carer, which is seriously affecting the health and wellbeing of the child or young person or contributing to hyperglycaemia as a reaction to this fear.

AND they meet one or more of the following criteria:

  • frequent significant hypoglycaemia—more than one episode a year of significant hypoglycaemia requiring external, third-party assistance; and/or
  • impaired awareness of hypoglycaemia; and/or
  • inability to recognise, or communicate about, symptoms of hypoglycaemia; and/or
  • significant fear of hypoglycaemia for the child/young person or a family member/carer, which is seriously affecting the health and wellbeing of the child or young person or contributing to hyperglycaemia as a reaction to this fear.

 

People with type 1 diabetes aged 21 years or older who have valid concessional status and have a high clinical need

Concessional Status

The required concessional status for this eligibility group is consistent with existing NDSS concessional arrangements but excludes the Safety Net Concession Card (SNCC) and the Safety Net Entitlement Card (SNEC) categories. People with the following valid concessional types will be eligible for the initiative (if they also meet the other eligibility criteria):

Concession Types

  • Commonwealth Seniors Health Card (as issued by DHS* or DVA**)
  • Commonwealth Pensioner Concession Card (as issued by DHS or DVA)
  • Commonwealth Health Care Card (as issued by DHS or DVA)
  • DVA Gold Card
  • DVA White Card
  • Identifies as Aboriginal and/or Torres Strait Islander person

*DHS Department of Human Services

**DVA Department of Veterans’ Affairs
 

Women with type 1 diabetes who are actively planning pregnancy, pregnant, or immediately post-pregnancy

To be eligible to access subsidised products through the NDSS:

  • the person is expected to benefit clinically from the use of CGM; and
  • the person or family/carer has the willingness and capability to use CGM; and
  • the person or family/carer has the commitment to actively participate in a diabetes management plan which incorporates CGM.

In addition, the person must meet the criteria in one of the following categories:

 

Category (A) Category (B)

The person with type 1 diabetes is considered as actively planning pregnancy and should be having regular engagement with pre-conception care services such as an endocrinologist, diabetologist and/or specialist physician, ideally at least every 6-8 weeks and more frequently if there is sub-optimal glycaemic control. An authorised health professional may certify eligibility for an initial 6-month period on the basis of the person seeking active pre-pregnancy care and committing to regular engagement with the pre-conception care service provider.

If at the end of the initial 6-month period the pre-conception care is continuing, an authorised health professional may certify eligibility for a further 6-month period. A maximum of two, 6-month access periods (up to a maximum period of 12 months) may be authorised.

There may be exceptional circumstances for an extension of this timeframe that will be considered on a case-by-case basis, noting these will be:

  • considered by an appropriately constituted expert panel established by Diabetes Australia that will provide a recommendation to the Department of Health; and
  • the Department of Health will be the deciding body for all of these cases.
  • Any extension to the pre-pregnancy period will be considered on a case-by-case basis and require documented evidence of exceptional circumstances – such as that the person has been referred to fertility services for assessment.

The person with type 1 diabetes has a confirmed pregnancy and is regularly engaging with a health professional such as an endocrinologist, diabetologist and/or specialist physician. An authorised health professional may certify eligibility that will continue until 3 months after the expected date of birth of the baby.


WHICH MEDTRONIC PRODUCTS ARE COVERED?

From 1 April 2019, Medtronic have seven products available through the CGM Initiative: Guardian™ 2 Link Transmitter, MiniLink™ Transmitter, Guardian Connect Transmitter, Enlite Sensor, Guardian Sensor 3, Guardian Link 3, Guardian Connect Transmitter. CGM technology enables a user to monitor glucose levels 24 hours a day through a sensor.


[i]  1. Mechanisms of hypoglycemia unawareness and implications in diabetes patients, Iciar Martin-Timon and Francisco Javier del Canizo-Gomez. World Journal of Diabetes. 2015

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