Australian Government subsidy of Continuous Glucose Monitors

Page last updated: 07 March 2017

The Australian Government is aware of the significant impact that diabetes has on individuals and their families, and is committed to working towards the broad prevention of the disease, and its associated complications, in the Australian community. A National Diabetes Strategy (2016-20) has been developed which will guide national action and priorities to prevent diabetes and support Australians living with diabetes.

During the 2016 Federal Election, the Government committed $54 million over four years to subsidise continuous glucose monitoring (CGM) technology to assist children and young adults under 21 years of age who face extra challenges managing their type 1 diabetes. The Government is committed to delivering this election commitment as soon as possible.

The Department of Health is currently finalising the IT changes, supply arrangements and communication materials needed to implement this initiative. The Department continues to consult with an Expert Advisory Group, which includes endocrinologists and paediatricians, as well as other key stakeholders including Diabetes Australia, the Juvenile Diabetes Research Foundation (JDRF) and the DANII Foundation.

Once the necessary changes are finalised, further information, including a commencement date, will be announced.

The Government provides considerable support to people with diabetes under other programs already in operation. This includes the subsidy of essential medicines, like insulin, under the Pharmaceutical Benefits Scheme and diabetes-related products through the NDSS.

The NDSS was established in 1987 to provide the subsidised products and services needed for the effective self-management of diabetes. It delivers subsidised syringes and needles, blood glucose test strips, urine ketone test strips and insulin pump consumables to people with diabetes. The NDSS also provides educational and information services to assist in the best use of products and self-management of diabetes.

In 2015-16 expenditure on medicines for diabetes was over $538 million and expenditure on products for diabetes supplied through the NDSS was over $198 million. This Government also funded $35 million to the JDRF Clinical Research Network to help find a cure for juvenile diabetes.

The Government also funds an Insulin Pump Programme to increase the affordability of insulin pumps and associated consumables for families who have children aged 18 years and under with type 1 diabetes but do not have access to other means of reimbursement, such as private health insurance.

People who have private health insurance may wish to contact their health insurer to discuss if they can already access a CGM device and consumables through their health insurance scheme. Private health insurers are required to pay benefits for items on the Prostheses List – Part C of which contains insulin pump devices, some of which have CGM or have glucose monitoring capability.

Access to these devices through existing private health insurance will depend on the type of general treatment cover and benefits offered. Availability and level of benefits varies between insurers and between private health insurance products. If a person with diabetes does not currently have general treatment cover, or the cover held does not currently include benefits for devices such as blood glucose level monitors, they would generally need to serve a waiting period after taking out or upgrading cover, to claim benefits.