Dáil Éireann Debate, Wednesday - 10 December 2025
351. Deputy Pádraig Rice asked the Minister for Health the reason reimbursement for continuous glucose monitors is only available to patients with type 1 diabetes who have required insulin from the outset; if reimbursement will be extended to patients diagnosed with type 2 diabetes who subsequently require insulin or develop type 1 diabetes later in life; and if she will make a statement on the matter. [70714/25]
Amharc ar fhreagraUnder the Health (Pricing and Supply of Medical Goods) Act 2013, the HSE has statutory responsibility for decisions on the pricing and reimbursement of medicines and medical devices; therefore, I have asked the HSE for an update in this matter.
The HSE has advised that the Health Information and Quality Authority (HIQA) Rapid Health Technology Assessment (HTA) of Continuous Glucose Monitoring (CGM) in Adults with Type 1 Diabetes Mellitus was published on 29th September 2023. The published document can be found at: www.hiqa.ie/reports-and-publications/health-technology-assessment/rapid-health-technology-assessment-continuous.
The HSE has also advised that in line with the advice from HIQA and due to the budget impact associated with CGM sensors, the HSE established a single national reimbursement application system for all CGM sensors on the reimbursement list on 01/12/2023.
Reimbursement support for CGM sensors at this point in time is based on the HIQA HTA and is for patients with type 1 diabetes mellitus regardless of age, who have required insulin from the outset. Reimbursement does not extend to other cohorts such as people with type 2 diabetes who require insulin, or patients previously diagnosed with type 2 diabetes which is now classified as type 1 diabetes based on laboratory investigations such as C-peptide measurement or diabetes-specific autoantibodies. To date, a HTA of CGM sensors for people with type 2 diabetes mellitus or other types of diabetes excluded from the HTA referenced above, such as latent autoimmune diabetes in adults (LADA), type 3c diabetes, monogenic forms of diabetes etc. has not been undertaken. Therefore, there is limited information to support the extension of reimbursement to this cohort, including cost-effectiveness assessment and budget impact of same.
An application for reimbursement support of CGM sensors can be submitted for any patient, and each application is reviewed centrally by the HSE-Medicines Management Programme (MMP) on a case-by-case basis.
If a prescriber wishes, the outcome of a negative decision can be appealed directly via email to the HSE Medicines Management Programme at mmp@hse.ie, or a new application can be submitted via the online application system. Appeals must be made by the patient’s clinician and should include any additional information to support the unmet clinical need for CGM sensors.
Appeals are reviewed on a case-by-case basis, reviewing the information provided in the initial online application and the information in the appeal submission to the HSE Medicines Management Programme. The final reimbursement recommendation is communicated back to the clinician via email or the online application system.
