Expanding Global Access Via CGM Reimbursement

Expanding Global Access Via CGM Reimbursement | Medtronic Diabetes, Between the Lines

Expanding access to our therapy to help more people with diabetes is central to our goal of transforming diabetes care for greater freedom and better health. In many parts of the world, insurance does not cover continuous glucose monitoring (CGM), despite clear evidence the technology has clinical and economic benefits.

Together, we face a CGM reimbursement challenge that requires a collaborative, collective effort. Over the past several years, we have advocated for expanding CGM coverage for all people with diabetes who can benefit from the therapy. Our team works across the globe towards this goal, and through our combined efforts, we are pleased to see progress around the world.

Australia

For years, we have worked closely with the Australian diabetes community, including patient and advocacy groups such as the JDRF, Diabetes Australia, and the Danii Foundation, clinicians, and industry partners to support, educate, and demonstrate the economic and clinical benefit of CGM.

Recently, bipartisan support for funding CGM was pledged during the Australia Federal Election period, bringing the diabetes community one-step closer to having access to this technology. Prior to the recent election, CGM coverage had not received Australian Government support because there was no established funding pathway for similar technology. Medical devices – such as CGM – that are not permanently implanted in the body do not fit the established reimbursement structure in Australia.

Germany

In June 2016, Germany’s Federal Joint Committee ruled its national health plans will cover CGM for people living with diabetes of all age groups who require intensive insulin therapy, regardless of whether they have type 1 or type 2 diabetes. Prior to this decision, there was no coverage for CGM in Germany.

Germany has the second largest diabetes population in Europe – after Russia – with 6.5 million people living with diabetes. In fact, they make up 10% of the diabetes population in Europe.[i]

For more than five years, our team has worked within the German system to make this change. The fact CGM is now reimbursed in Germany is a major accomplishment for people with diabetes.

With this reimbursement decision, Germany will have broader CGM coverage than the United Kingdom’s National Institute for Health and Care Excellence (NICE). Last August, for the first time, NICE’s clinical guidelines recommended the MiniMed Paradigm Veo and the MiniMed 640G systems – which are both approved outside of the U.S – to manage type 1 diabetes and dangerous lows —concluding that their adoption has the potential to save the UK health system £1,500 ($1,950 USD) per person, per year.

Successful reimbursement in Australia and Germany will help expand access to diabetes therapy and solutions for people with diabetes in those countries, and sets a positive precedent for future therapy to be reimbursed, particularly in automated insulin delivery.

United States

Even in the U.S., where nearly 95% of commercial payers have a coverage policy for CGM, there is still work to do to implement coverage for personal CGM for people on Medicare. For more than two years, we have been part of a coalition engaged in an effort to support legislation that will expand coverage. These efforts are necessary to ensure people with diabetes who enter the Medicare program at age 65 do not experience disruption in their diabetes management.

Through the coalition, we have directly engaged Centers for Medicaid Services (CMS) and created legislative options. Legislation has been introduced in both the Senate and House of Representatives, and has the support of senators and representatives. The legislation would require CMS to cover personal CGM for patients with type 1 diabetes.

You can help this initiative by contacting your local Senate Finance Committee and House Committee on Ways and Means to urge them to get onboard as co-sponsors of this important bill.

We are committed to cultivating relationships with governments and health systems to remove barriers to affordable diabetes care worldwide.

[i] International Diabetes Federation. http://www.idf.org/membership/eur/germany

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