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Reimbursement summary for angioplasty of arteries of lower extremities

This post presents an extract from our reimbursement analysis for angioplasty of arteries lower extremities using plain and drug-coated balloons (DCBs) for peripheral artery disease in England, France and Germany. Plain balloon angioplasty is reimbursement via DRG solely and DCBs are reimbursement via combination of DRG and add-on reimbursement.
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Flash Glucose Monitoring: national funding in England

05 Apr 2019

The NHS Long Term Plan announced, on March 7, 2019, that ‘the NHS will ensure, in line with clinical guidelines, patients with type 1 diabetes benefit from life changing flash glucose monitors from April 2019, ending the variation patients in some parts of England are facing’. Flash Glucose Monitoring is appropriate for certain people with diabetes alongside other technologies for people with differing diabetes management needs. The guidance sets out the criteria for flash glucose monitoring and the maximum amounts CCGs will be reimbursed for the ongoing costs of the flash glucose sensors.

An NHS England initiative delivered in partnership with England’s 15 Academic Health Science Networks (AHSNs), the NHS Innovation Accelerator (NIA) has supported the uptake and spread of 37 high impact, evidence-based innovations across more than 1,700 NHS sites since it launched in July 2015.

Criteria for NHS England Flash Glucose Monitoring reimbursement:

  • People with Type 1 diabetes OR with any form of diabetes on hemodialysis and on insulin treatment (who, in either of the above, are clinically indicated as requiring intensive monitoring >8 times daily, as demonstrated on a meter download/review over the past 3 months) OR with diabetes associated with cystic fibrosis on insulin treatment
  • Pregnant women with Type 1 Diabetes - 12 months in total inclusive of postdelivery period.
  • People with Type 1 diabetes unable to routinely self-monitor blood glucose due to disability who require carers to support glucose monitoring and insulin management
  • People with Type 1 diabetes for whom the specialist diabetes MDT determines have occupational (e.g. working in insufficiently hygienic conditions to safely facilitate finger-prick testing) or psychosocial circumstances that warrant a 6-month trial of Libre with appropriate adjunct support
  • Previous self-funders of Flash Glucose Monitors with Type 1 diabetes where those with clinical responsibility for their diabetes care are satisfied that their clinical history suggests that they would have satisfied one or more of these criteria prior to them commencing use of Flash Glucose Monitoring had these criteria been in place prior to April 2019 AND has shown improvement in HbA1c since selffunding
  • For those with Type 1 diabetes and recurrent severe hypoglycemia or impaired awareness of hypoglycemia, NICE suggests that Continuous Glucose Monitoring with an alarm is the standard. Other evidence-based alternatives with NICE guidance or NICE TA support are pump therapy, psychological support, structured education, islet transplantation and whole pancreas transplantation. However, if the person with diabetes and their clinician consider that a Flash Glucose Monitoring system would be more appropriate for the individual’s specific situation, then this can be considered

From April 1, 2019, for patients who satisfy these criteria, NHS England will reimburse CCGs for the ongoing costs of flash glucose sensors. These criteria are estimated to represent up to 20% of England’s type 1 diabetes population. The national funding arrangements are time limited to include 2019/20 and 2020/21, which will allow time for CCGs and prescribers to implement NICE guidelines and recoup the financial benefits of Flash Glucose Monitoring usage.

See full details here.

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