Access to Continuous Glucose Monitoring through the NDSS
Updated 21 February 2019
The Australian Government provides access to fully subsidised CGM through the NDSS. Subsidised access to CGM products is available through the NDSS for eligible people. The CGM Initiative aims to assist in the:
- reduction of the number of severe hypoglycaemic events;
- improvement of blood glucose control in people with poor glycaemic awareness or suboptimal glycaemic control (better control of blood glucose levels is associated with a reduced prevalence of long-term complications of diabetes);
- reduction of visits to emergency departments, and missed work and/or school days by helping eligible people and their families to better manage their type 1 diabetes; and
- reduction in anxiety for eligible people with type 1 diabetes.
CGM devices assist users with type 1 diabetes to manage their blood glucose levels and control their diabetes. Providing access to subsidised CGM sensors and transmitters may assist these people to better manage their blood glucose levels, and may reduce stress, anxiety and emergency visits to the hospital. CGM devices can also assist users with other rare conditions that are very similar to type 1 diabetes.
If you are interested in learning more about CGM and whether it might be right for you or your child, we encourage you to speak with your diabetes healthcare team to see if this could help you and your family in managing your or your child’s diabetes. You can also call the NDSS Helpline on 1300 136 588. The Helpline operates during 8:30am to 5pm Monday to Friday and from 9am to 12pm on Saturdays and national public holidays.
To be eligible for the initiative you must be registered with the NDSS. More information on registration with the NDSS is available by clicking here.
What is CGM?
A CGM device is a small wearable device that measures glucose levels throughout the day and night. It has alarms to let the user know if glucose levels are getting too low or too high, what their glucose level is at any time, and whether it is stable or on the way up or down. These devices reduce the frequency of daily finger prick blood glucose checks. Some devices can work in conjunction with a compatible insulin pump while others send information to a CGM receiver or smartphone.
Product Selection and Use
Selection of an appropriate CGM device should be made by the authorised health professional based on their clinical assessment. This assessment should take into account the indicated use for each CGM device, noting that not all products may be appropriate for all eligibility groups.
The choice of which specific device to be used is a decision of the authorised health professional in consultation with, and with the informed consent of, the person and/or their carer. Please view the NDSS Device Summary and Compatibility Chart for information about the devices subsidised through the NDSS, their compatibility with insulin pumps and smart devices and links to guidelines about appropriate use.
From 1 April 2019, the NDSS will provide subsidised access to the products on the Medtronic Guardian (3) platform. The Government also intends to include the FreeStyle Libre flash glucose monitoring system on the list of products subsidised under the scheme. Negotiations with the product sponsor are ongoing and further information will be provided once negotiations are complete.
Eligibility to Access Subsidised CGM Products through the NDSS
To access CGM products through the NDSS, the person will need to be assessed by an authorised health professional to determine whether they meet specific eligibility criteria and to ensure that the use of CGM will help as part of their diabetes management.
The authorised health professionals who can perform these assessments include endocrinologists, credentialled diabetes educators, and other health professionals specialising in diabetes (medical doctors, paediatricians or nurse practitioners). To be eligible to participate in the CGM Initiative, the person must be assessed by an authorised health professional and meet the criteria for one of the following groups:
- Children and young people aged under 21 years with type 1 diabetes
- People with type 1 diabetes aged 21 years or older who have valid concessional status and have a high clinical need
- Women with type 1 diabetes who are actively planning pregnancy, pregnant, or immediately post-pregnancy
- Children and young people under 21 years with conditions very similar to type 1 diabetes who require insulin
If a person does not meet the specific clinical criteria but their health professional believes that the person does have an equivalent level of high risk / high clinical need, consideration may be given on a case-by-case basis.
In these exceptional circumstances, consideration may be given 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.
To learn more about submitting a special consideration application, please contact the NDSS Helpline on 1300 136 588.
To submit an application, a completed eligibility assessment form and supporting documentation outlining the assessment of equivalent level of high risk/high clinical need prepared and certified by an authorised health professional should be emailed to the NDSS at email@example.com, or alternatively posted to GPO Box 9824 in your capital city, or faxed to 1300 536 953.For more information, please call the NDSS Helpline on 1300 136 588.
This is a new initiative and in this context, each application for special consideration requires careful review to determine if the eligibility and the criteria have been met in order to be granted access. The expert committee handling requests for special consideration will need time to consider applications before arriving at any outcome. The Department of Health will also be monitoring the progress of the initiative to facilitate consideration for those with the greatest clinical need.