This welcome development will end the variability of access across England that we have seen since Flash was added to NHS Tariff in November 2017.
Read the NHS England arrangements for funding effective from 1 April 2019.
In March 2020 Jo Churchill, Parliamentary Under-Secretary for Health and Social Care estimated that 24% of people with type 1 diabetes in England have been prescribed flash glucose monitoring on the NHS. To see how your local CCG compares, visit OpenPrescribing, add your CCG name in the box and press “Show me the data”
The following criteria are set by NHS England, who will reimburse your CCG most of the cost of flash glucose monitoring. This measure is intended to allow 20% of those with type 1 diabetes to access Flash from the NHS. Your local CCG cannot add extra criteria to these, although they may provide Flash to an additional group of people but will not receive NHS reimbursement for those people.
Criteria for NHS funding for flash glucose sensing (England)
Criteria for NHS England Flash Glucose Monitoring Reimbursement
1. 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 three months OR with diabetes associated with cystic fibrosis on insulin treatment
2. Pregnant women with type 1 diabetes – 12 months in total inclusive of postdelivery period.
3. 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.
4. 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.
5. 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 self funding.
6. 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.
1. Education on Flash Glucose Monitoring has been provided (online or in person)
2. Agree to scan glucose levels no less than 8 times per day and use the sensor more than 70% of the time
3. Agree to regular reviews with the local clinical team.
4. Previous attendance, or due consideration given to future attendance, at a type 1 diabetes structured education programme (DAFNE or equivalent if available
Continuing prescription for long-term use of Flash Glucose Monitoring-post initial 6 months- would be contingent upon evidence of agreeing with the above conditions and that on-going use of the Flash Glucose Monitoring is demonstrably improving an individual’s diabetes self-management- for example improvement of HbA1c or Time In Range; improvement in symptoms such as DKA or hypoglycaemia; or improvement in psycho-social wellbeing
Northern Ireland, Wales and most of Scotland have already had their appropriate NHS funding bodies agree to provide flash, but the criteria are varied.
People who do not get Libre on prescription will still be able to buy direct from Abbott. Some local pharmacies are selling Libre at a discounted price – ask the diabetes online community on social media for locations of those pharmacies.
Please note the Libre website & webshop (be sure to tick the VAT exemption box) is still closed to new customers so that Abbott can ensure they meet the demand for NHS supplies.
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