NDSS CGM Subsidy
The Australian Government has recently announced that it will now provide access, through the National Diabetes Services Scheme (NDSS), to fully subsidised continuous glucose monitoring (CGM) products. This includes CGM sensors and transmitters, which is available to children and young people aged under 21 years, living with type 1 diabetes, who meet a specific criteria.
CGMs have been shown to assist children and young people, and their families, to better manage blood sugar levels. Benefits of using a CGM can include reduce stress, anxiety and emergency visits to the hospital.
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 Isabel at InRange Diabetes to see if this could help you and your family in managing your child’s diabetes.
InRange can also assist in assessing eligibility, preparing NDSS CGM application forms, CGM training, CGM readouts and calibrations.
With a GP management plan from your doctor, up to five CGM related appointments can be bulk billed, so you don’t have to worry about any additional costs to get up and running.
As a supporter of the DANII foundation, InRange will ensure that your appointment is a priority and the assessment & application is fast tracked, as we want to ensure that you are always InRange.
Children 10 years of age or younger
Children 10 years of age and younger with type 1 diabetes will be eligible for subsidised access to CGM if they fulfill ALL of the following criteria:
- the child is aged up to ten (10) years of age with type 1 diabetes, and
- the child is expected to benefit clinically from the use of CGM, and
- the family/carer has the willingness and capability to use CGM, and
- the family/carer has the commitment to actively participate in a diabetes management plan which incorporates CGM.
Children and young people aged 11 to less than 21 years
Children and young people with type 1 diabetes aged from 11 years to less than 21 years will be eligible for subsidised access to CGM sensors and transmitters if they fulfil ALL of the following criteria:
- the individual is expected to benefit clinically from the use of CGM, and
- the individual or family/carer has the willingness and capability to use CGM, and
- the individual or family/carer has the commitment to actively participate in a diabetes management plan which incorporates CGM.
- requent significant hypoglycaemia—more than one episode a year of significant hypoglycaemia requiring external, third party assistance, and/or
- impaired awareness of hypoglycaemia, and/or
- inability to recognise, or communicate about, symptoms of hypoglycaemia, and/or
- significant fear of hypoglycaemia for the child/young person or a family member/carer which is seriously affecting the health and wellbeing of the child or young person or contributing to hyperglycaemia as a reaction to this fear.
Are you over 21 with type 1 diabetes
All people with type 1 diabetes are eligible to apply for access to subsidised CGM and Flash GM products through the NDSS. People with type 1 diabetes aged 21 years and older who hold valid concessional status can access fully subsidised products, that is, no co-payment will be required. If you do not have valid concessional status, or your concessional access ends, you will pay a co-payment when you purchase at a NDSS Access Point (usually a community pharmacy).
To be eligible to access subsidised CGM and Flash GM products through the NDSS:
To be eligible to access subsidised CGM and Flash GM products through the NDSS:
- the person is expected to benefit clinically from the use of CGM or Flash GM; and
- the person or family/carer has the willingness and capability to use CGM or Flash GM; and
- the person or family/carer has the commitment to actively participate in a diabetes management plan which incorporates CGM or Flash GM.
Are you under the age of 50 and have type 2 diabetes requiring insulin? Or did you progress to insulin quickly following diagnosis of type 2 diabetes (at any current age)
Latent Autoimmune Diabetes in Adults (LADA) is a type of diabetes that begins in adulthood and gradually worsens over time. Similar to Type 1 diabetes, LADA occurs when the pancreas stops producing insulin due to an autoimmune process that damages pancreatic cells. However, unlike Type 1 diabetes, this process in LADA happens slowly.
People with LADA often do not need insulin immediately but may require it sooner than those with Type 2 diabetes. With LADA, you can register as having Type 1 diabetes through the National Diabetes Services Scheme (NDSS) and gain access to subsidized Continuous Glucose Monitoring (CGM).
A simple pathology test can distinguish between Type 1 and Type 2 diabetes, and I can arrange this test for you if needed.
(reference: Latent autoimmune diabetes in adults (LADA): What is it? – Mayo Clinic)
People with LADA often do not need insulin immediately but may require it sooner than those with Type 2 diabetes. With LADA, you can register as having Type 1 diabetes through the National Diabetes Services Scheme (NDSS) and gain access to subsidized Continuous Glucose Monitoring (CGM).
A simple pathology test can distinguish between Type 1 and Type 2 diabetes, and I can arrange this test for you if needed.
(reference: Latent autoimmune diabetes in adults (LADA): What is it? – Mayo Clinic)
Do you have type 1 diabetes and a concession
The required concessional status to access fully subsidised CGM and Flash GM products is consistent with existing NDSS concessional arrangements but excludes the Safety Net Concession Card (SNCC) and the Safety Net Entitlement Card (SNEC) categories. People with type 1 diabetes aged 21 years or older with the following valid concessional types will be eligible for fully subsidised products:
Concession types
Concession types
- Commonwealth Seniors Health Card (as issued by DHS* or DVA**)
- Commonwealth Pensioner Concession Card (as issued by DHS or DVA)
- Commonwealth Health Care Card (as issued by DHS or DVA)
- DVA Gold Card
- DVA White Card
- Identifies as Aboriginal and/or Torres Strait Islander person
Do you have Type 2 diabetes and a DVA card?
Veteran Gold Card holders, or White Card holders with diabetes as an accepted condition.
For more information visit the DVA website.
Use of CGMs have been found to improve the lives of people living with diabetes by providing them a greater understanding of their condition, enabling them to better manage their glucose levels and reduce the risk of complications.
DVA’s Rehabilitation Appliances Program (RAP), provide CGMs through contracted suppliers by completing the Diabetes Products Order Form.
Clients using CGMs will be placed on a subscription and will be provided with sensors every three (3) months, which will be delivered to their home address on an ongoing basis. If a client does not wish to be automatically subscribed to this service, please note this on their form.
For more information visit the DVA website.
Use of CGMs have been found to improve the lives of people living with diabetes by providing them a greater understanding of their condition, enabling them to better manage their glucose levels and reduce the risk of complications.
DVA’s Rehabilitation Appliances Program (RAP), provide CGMs through contracted suppliers by completing the Diabetes Products Order Form.
Clients using CGMs will be placed on a subscription and will be provided with sensors every three (3) months, which will be delivered to their home address on an ongoing basis. If a client does not wish to be automatically subscribed to this service, please note this on their form.
Are you pregnant or planning pregnancy?
Part A – Pregnancy Planning
The woman with type 1 diabetes is considered as actively planning pregnancy and should be having regular engagement with pre-conception care services such as an endocrinologist, diabetologist and/or specialist physician, ideally at least every 6-8 weeks and more frequently if there is sub-optimal glycaemic control. A health professional authorised to assess and certify eligibility to access CGM or Flash GM products for an initial 6-month period on the basis of the person seeking active pre-pregnancy care and committing to regular engagement with the pre-conception care service provider.
If at the end of the initial 6-month period the pre-conception care is continuing, an authorised health professional may certify eligibility for a further 6-month period. A maximum of two, 6-month access periods (up to a maximum period of 12 months in total) may be authorised.
Part B – Pregnant or Immediately Post Pregnancy
The woman with type 1 diabetes has a confirmed pregnancy and is regularly engaging with a health professional such as an endocrinologist, diabetologist and/or specialist physician. An authorised health professional may certify eligibility that will continue until 3 months after the expected date of birth of the baby.
Eligibility period
Part A: Pregnancy planning
Up to 12 months (initial period of 6 months with a subsequent period of an additional 6 months on confirmation that pre-pregnancy care is continuing).
When a woman with type 1 diabetes no longer meets the eligibility criteria for pregnancy planning they should consult their diabetes health professional to discuss eligibility to continue to access subsidised CGM or Flash GM products through the NDSS.
Part B: Pregnant or Immediately Post Pregnancy
From when the pregnancy is confirmed, until 3 months after the expected or actual date of birth of the baby.
In the event of a pregnancy loss, the currently approved period of CGM and Flash GM access will continue unchanged. In this event, the person may reapply for pregnancy planning status at any time.
When a woman with type 1 diabetes no longer meets the eligibility criteria for pregnancy or immediately post-pregnancy they can continue to access fully subsidised products if they have valid concessional status. If they do not have valid concessional status, they will commence paying a co-payment.
At least 1 month prior to the completion of either the ‘pregnancy planning’ or ‘post–pregnancy’ periods, the person will receive a notification from the NDSS, advising them that their access to fully-subsidised products is ending soon and guidance for ongoing access to subsidised products through the NDSS, including if they should consult their authorised health professional in relation to future access.
The woman with type 1 diabetes is considered as actively planning pregnancy and should be having regular engagement with pre-conception care services such as an endocrinologist, diabetologist and/or specialist physician, ideally at least every 6-8 weeks and more frequently if there is sub-optimal glycaemic control. A health professional authorised to assess and certify eligibility to access CGM or Flash GM products for an initial 6-month period on the basis of the person seeking active pre-pregnancy care and committing to regular engagement with the pre-conception care service provider.
If at the end of the initial 6-month period the pre-conception care is continuing, an authorised health professional may certify eligibility for a further 6-month period. A maximum of two, 6-month access periods (up to a maximum period of 12 months in total) may be authorised.
Part B – Pregnant or Immediately Post Pregnancy
The woman with type 1 diabetes has a confirmed pregnancy and is regularly engaging with a health professional such as an endocrinologist, diabetologist and/or specialist physician. An authorised health professional may certify eligibility that will continue until 3 months after the expected date of birth of the baby.
Eligibility period
Part A: Pregnancy planning
Up to 12 months (initial period of 6 months with a subsequent period of an additional 6 months on confirmation that pre-pregnancy care is continuing).
When a woman with type 1 diabetes no longer meets the eligibility criteria for pregnancy planning they should consult their diabetes health professional to discuss eligibility to continue to access subsidised CGM or Flash GM products through the NDSS.
Part B: Pregnant or Immediately Post Pregnancy
From when the pregnancy is confirmed, until 3 months after the expected or actual date of birth of the baby.
In the event of a pregnancy loss, the currently approved period of CGM and Flash GM access will continue unchanged. In this event, the person may reapply for pregnancy planning status at any time.
When a woman with type 1 diabetes no longer meets the eligibility criteria for pregnancy or immediately post-pregnancy they can continue to access fully subsidised products if they have valid concessional status. If they do not have valid concessional status, they will commence paying a co-payment.
At least 1 month prior to the completion of either the ‘pregnancy planning’ or ‘post–pregnancy’ periods, the person will receive a notification from the NDSS, advising them that their access to fully-subsidised products is ending soon and guidance for ongoing access to subsidised products through the NDSS, including if they should consult their authorised health professional in relation to future access.
Links
You can find more information from the Department of Health by clicking here.
The Department of Health will also be sending direct communications out to people with diabetes who may be eligible, authorised health professionals, and NDSS Access Points. You can the Department of Health’s brochure on the CGM initiative here.
Further information related to NDSS and the CGM subsidy can be found here.