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Insulin pump choice and CGM quantity limits

Kia ora,

 

We are writing regarding funded diabetes technology, specifically insulin pump choice, and quantity limitations for continuous glucose monitors (CGMs), and the process to follow when encountering faulty devices.

 

Insulin pump choice


Since October 2024, Pharmac has funded two insulin pumps for people meeting eligibility criteria. A table comparing the various features and differences between the two pumps is on the Pharmac website. Pump selection is considered ‘permanent’ for the warranty period of four years (i.e. selection is a 4-year decision), so it is important that initial pump selection is patient-centred and aligns with the individual’s lifestyle and health needs (e.g. does the person have access to a smartphone; does the pump allow for the daily insulin amount required).


The "Maximum of 1 insulin pump per patient each four-year period" rule does not apply for people changing from a funded Medtronic pump to the Tandem or YpsoPump. They can receive a funded pump, even if they got their Medtronic pump less than 4 years ago. Note the consumables for the Medtronic pump will all be delisted by 1 October 2026.

 

Quantity limitations for CGMs


Patients should be made aware of the maximum limit of CGMs funded per year, and the process for reporting / replacing faulty CGMs if required. The year runs for 12 months from when the Special Authority is issued and every subsequent 12-month period. Current limits are as follows:


FreeStyle Libre 2 Plus


  • Up to 28 devices will be funded each year.

  • Up to 6 devices on each prescription. 


Dexcom ONE+


  • Up to 40 devices will be funded each year.

  • Up to 9 devices on each prescription.


Freestyle Libre 3 Plus


  • Up to 28 devices will be funded each year.

  • Up to 6 devices on each prescription.


Dexcom G6


  • Up to 5 packs will be funded each year.

  • Up to 1 pack on each prescription.

  • Each pack contains 1 transmitter and 9 sensors


Dexcom G7


  • Up to 40 devices will be funded each year.

  • Up to 9 devices on each prescription.


Sensors should only be changed as directed (i.e. not more frequently). If an individual has a CGM that fails, they need to contact the relevant supplier to report the issue and seek replacement at the time of the issue to avoid reaching their maximum device limit . Device failure can include not initiating a session, the connection failing before the total days for the device or not sticking despite appropriate application. If a patient has any other issues with application or use, they should also reach out to the supplier for resolution

If an individual requires more devices than the funded maximum due to issues not related to the functioning of the device (i.e. for a clinical reason), their prescriber can request permission to increase the allocation. You can do this through the Special Authority Waiver process.

 

More information is available:

 

Questions: 

If you have any queries, please contact us at enquiry@pharmac.govt.nz or if regarding a Special Authority Waiver -  waivers@pharmac.govt.nz

 

Please share this information:

Please share this information with your colleagues and within your networks.

           

 

Ngā mihi,

 

Georgia I Senior Advisor Implementation

Pharmac | Te Pātaka Whaioranga | PO Box 10 254 | Level 9, 40 Mercer Street, Wellington

P: 0800 660 050 | www.pharmac.govt.nz

 


 

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