As most of you will know the Freestyle Libre was made available covered on our long term illness scheme during 2018 on a trial basis.
During that trial period the HSE would be looking for any possible blood glucose test strip use being reduced.
In short, when The Minister for Health made his seemingly good news announcement in January, not only was it discriminating against adults with type 1 Diabetes but it had an awful lot of strings attached to it, unlike other countries that made it available to anyone wanting to avail of it.
This is how it works, your pharmacist will have a record of the blood glucose strips you ordered and collected monthly, once that same customer orders the Libre on their LTI then they should have been ordering and collecting less blood glucose test strips monthly. This would automatically show the HSE that the Libre was cost effective.
But has that worked ?
Looking at some of the information we have received some people are testing at least 4 times daily while using the Libre that has been covered in their LTI, while others are testing less.
However on a patient by patient basis can you show that your test strip order and collection monthly is reduced ?
What about those who had been self funding the Libre before it being covered on LTI, would this mean the reduction in test strip use happened during that time, once those folk moved to the Libre covered on LTI there would be no further reduction in test strip use, sure how could there be ?
So what happens if the Libre does not prove to be cost effective after 12 months data has been analyzed?
We don’t know the answer to this but we are afraid that maybe adults won’t be included in receiving the Libre covered on their LTI because it’s been proven that in the under 21 group less test strip usage has not materialized.
– Why has this not happened ?
– Was it lack of trust in the Libre?
– Was it that wearing the Libre was just a back up mechanism?
My feeling on this, is that it should have been given to a cross section of our diabetes community, with a stipulation ( if that’s what the HSE were looking for ) that after the first month or so, once a person was used to using it, they would then commit to it and order less test strips monthly or make a decision not to use it anymore and go back to regular blood glucose testing.
In short the Libre for those of us in Ireland was never going to be an “extra” option and would have come with an anticipation of Less test strips used per patient and if more were necessary then a cover letter from a diabetes consultant would have explained clinical need.
This whole Libre situation has been shrouded in grey areas since it was announced that the 4-21 age group would be covered.
Nothing about this has been Chrystal clear since the announcement was made back in January of this year, and there has certainly been no commitment to either continue it to those already getting it or extend it to adults.
I totally understand that as a parent of a child with type 1 diabetes, that person would have to be very diligent and responsible when managing a child’s blood glucose but what if the Libre is taken off LTI cover because of lack of cost effectiveness? Then everyone will be without it.
Is it even possible under the current circumstances that everyone presently getting the Libre covered on their LTI have a responsibility to prove cost effectiveness for the sake of all who need it and are at present using it, also for the sake of those over 21 hoping to be included next year.
Please take a moment or two to read the latest answers we have received to parliamentary questions that have been asked in regard to this and you’l see why we are concerned.
FYI : Insulin pumps and CGMs are already covered on LTI
Primary Care Reimbursement Service
Exit 5, M50, North Road, Finglas,
Dublin 11, Dll XKF3
Tel: 01- 8647100
Mr. Kieran Healy, T.D.
Kildare Street, Dublin 2.
20th November, 2018
To a the Minister for Health the number of persons under 21 years of age that have access to the FreeStyle Libre under the long-term illness scheme; the number of persons over 21 years of age that now have access to the FreeStyle Libre over the long-term illness scheme in tabular form by CHO and county; and if he will make a
statement on the matter. – Mary Butler
statement on the matter. – Mary Butler
Dear Deputy Butler,
The Health Service Executive has been requested to reply directly to you in the context of the above Parliamentary Question (Reference 47152/18), which you submitted to the Minister for Health for response.
The decision to approve reimbursement for the use of the Free Style Libre glucose monitoring system, under the Long Term Illness (LTI) scheme, was taken in the expectation that the additional costs associated with Free Style Libre would be offset by reduction in the cost of glucose monitoring ancillaries. There will be a review after twelve months to look at evidence of effectiveness of the device and to ensure that costs are in line with expectations. The HSE is scoping the data monitoring requirements to inform the final review, however, it is not in a position to report until June 2019 after twelve months claiming data has been submitted by pharmacy contractors.
At the 24. October 2018, when the data was last reviewed, there were 2,227 persons approved – aged under 21 years, and 31 persons approved – over the age of 21.
The HSE PCRS does not collate data to support a mom refined breakdown by Community Healthcare Organisation (CHO) area, or by county.
To ask the Minister for Health if he will provide a cost-benefit analysis in relation to usage of the finger test strips for persons between 5 and 21 years of age with type 1 diabetes; if it has provided savings over the past six months since the FreeStyle Libre reimbursement scheme was launched; and if he will make a statement on the matter. -Mary Butler
Dear Deputy Butler,
The Health Service Executive has been requested to reply directly to you in the context of the above Parliamentary Question (Reference 45044/18), which you submitted to the Minister for Health for response.
The HSE agreed in principle to reimburse Freestyle Libre on an individualised basis in fine with the recommendations of the Health Technology Assessment Group. Report attached.
Approval was confined to children and young adults in the first instance who require multiple dose injections of insulin with a review to be conducted after twelve months to ascertain whether the expected ‘offset’ reductions in glucose monitoring ancillaries materialise.
Only six months data is currently available. Initial indications do not signal an absolute reduction in expenditure occasioned by use of the FreeStyle Libre. The HSE is scoping the data monitoring requirements to inform the final review which is not in a position to report until June 2019 after twelve months claiming data has been submitted by pharmacy contractors
IMPORTANT INFORMATION*For those who think diabetes is caused by an unhealthy lifestyle let me clarify a couple of things.
Type 1 Diabetes happens because our own antibodies attack and destroy an organ in the body. it’s an autoimmune response where antibodies that normally fight disease mistake a part of our body(the pancreas in this case) as foreign and attack to destroy it.When those antibodies attack the insulin-producing islets in the pancreas we stop producing insulin so we need to inject or pump it.Without insulin a person with type 1 diabetes would die. At present it is not known what causes this to happen, and there is no cure.A person with Type 1 diabetes MUST inject or pump insulin to stay alive.There are many factors that contribute to a diagnosis of Type 2 diabetes so pre judgment of a lifestyle choice is unfair at very least.A person with Type 2 diabetes, while still producing their own insulin for various reasons their body cannot use it correctly or efficiently.These people are generally treated with oral medications and sometimes with insulin injections.