Changes to the National Diabetes Services Scheme (NDSS) June 2016 FREQUENTLY ASKED QUESTIONS 1. What are the changes from 1 July 2016? 2. Why are the supply changes happening? 3. What is the role of Diabetes Australia in administering the NDSS? 4. Will registrants still be able to access the NDSS telephone service? 5. Will Access Points require a new Access Point Agreement from 1 July 2016? 6. How does my pharmacy become an NDSS Access Point? 7. Will registrants still be able to access support from Diabetes Australia and state or territory diabetes organisations? 8. Will the cost of NDSS products change? 9. Will registrants be able to order diabetes products online? 10. Will there be a change in how the Access Points order NDSS products? 11. What are the new restrictions for accessing blood glucose test strips (BGTS)? 12. Why are the new restrictions on blood glucose test strips being implemented? 13. How do registrants access more blood glucose test strips after six months? 14. Who are the authorised health professionals that can approve extensions for access to blood glucose test strips? 15. Is there a form a medical doctor or authorised health professional needs to fill out for people to access blood glucose test strips? 16. What do pharmacy staff need to do with the authorisation form? 17. What about people with other types of diabetes. Can they still access blood glucose test strips? 18. Will blood glucose test strips remain listed on the PBS? 19. Will insulin pump consumables be available from community pharmacy Access Points? 20. Do Access Points need to stock all Insulin Pump Consumable (IPC) products? 21. How are IPCs ordered? 22. Will pharmacy staff receive training? 23. What advice can I give to IPC users who are enquiring about ordering stock? 24. Will the co-payment for diabetes products change? This document has been adapted from the information provided by NDSS and the Department of Health.
1. What are the changes from 1 July 2016? From 1 July, NDSS products will only be available through community pharmacies that are NDSS Access Points. These products will be supplied through the pharmaceutical wholesaler distribution network, the same network that supplies PBS medicines, at no cost to the pharmacy. Access Points will be eligible to receive a payment of $1.00 for each NDSS product supplied from 1 July 2016. From 1 July 2016, in addition to supplying blood glucose test strips, needles and syringes as part of the NDSS, community pharmacy Access Points will supply insulin pump consumables (IPCs). Restrictions in accessing blood glucose test strips on the NDSS will also come into effect from 1 July 2016. 2. Why are the supply changes happening? The changes will mean a more efficient distribution of NDSS products as they will be supplied through the existing PBS medicine wholesaler supply network. 3. What is the role of Diabetes Australia in administering the NDSS? A new NDSS Agreement with Diabetes Australia will come into effect from 1 July 2016. Diabetes Australia will continue to administer the NDSS. There are no changes to support or education services provided by Diabetes Australia. Diabetes Australia will continue to register people with diabetes to the NDSS, provide education and support for registrants and Access Points, maintain the NDSS database and systems, and manage payments to Access Points and the collection of NDSS Registrant co-payments. 4. Will registrants still be able to access the NDSS telephone service? Yes. Access to the NDSS Helpline 1300 136 588 will not change. Registrants and pharmacy staff can still get advice about diabetes products over the phone through Diabetes Australia. However, registrants will no longer be able to order NDSS products over the phone, through Diabetes Australia shops or Diabetes Australia agent websites. The only exception is that there will be a short transition period of two months to assist IPC users with the changes. This will allow registrants the option to purchase IPCs from their community pharmacy Access Point or from their state/ territory diabetes organisation. This will continue to 31 August 2016. 5. Will Access Points require a new Access Point Agreement from 1 July 2016? New Access Point Agreements will be established between the Commonwealth and individual Access Points early in the new financial year, and will be managed by Diabetes Australia. To cover the interim period, Access Points will be offered an extension of the agreement by letter in June. Pharmaceutical Society of Australia Ltd. I 2
6. How does my pharmacy become an NDSS Access Point? To enquire about becoming an NDSS Access Point, contact the NDSS Helpline on 1300 136 588 in the first instance. 7. Will registrants still be able to access support from Diabetes Australia and state or territory diabetes organisations? Yes. Support and advice from Diabetes Australia about NDSS products, and self-management of diabetes, will continue to be provided to all NDSS registrants over the phone (1300 136 588) and through ongoing education programs. 8. Will the cost of NDSS products change? There are no changes to price or range of NDSS products. From 1 July 2016, the co-payment a registrant pays for products will not change. Access Points may choose to charge for home delivery or postage if these are required. 9. Will registrants be able to order diabetes products online? No. The ordering process is changing from 1 July 2016, and a registrant will no longer be able to order products over the phone, through Diabetes Australia shops or online via Diabetes Australia agent websites. Registrants will need to order and collect products from their local NDSS community pharmacy Access Point. If a registrant lives a long distance from the pharmacy it may be useful to discuss setting up regular ordering of their products so that they are available when they next visit the pharmacy. However, to assist IPC users with the changes, there will be a short-term transition period of two months that will allow registrants the option to purchase IPCs directly from their community pharmacy Access Point or by mail from their state/territory diabetes organisation. This will continue to 31 August 2016. Where products are ordered by mail, registrants will be required to pay for postage. 10. Will there be a change in how the Access Points order NDSS products? Access Points will continue to use NDSS Connect for ordering and confirming eligibility for products. Replacement of stock carried by the pharmacy will continue with replacement stock usually provided within 24 hours. Items not stocked by the Access Point, such as IPCs, can be ordered on demand and be delivered usually within 24 hours. 11. What are the new restrictions for accessing blood glucose test strips (BGTS)? Starting from 1 July 2016, all registrants with type 2 diabetes not using insulin will be eligible for an initial six month supply of subsidised blood glucose test strips. This means that they will be able to purchase blood glucose test strips, as required, over a six month period. This change follows the independent advice of the expert Pharmaceutical Benefits Advisory Committee. The initial six month access period will commence from the date that blood glucose test strips are first purchased on or after 1 July 2016. (For example, if a person buys NDSS blood glucose test Pharmaceutical Society of Australia Ltd. I 3
strips in May and then again in August, the 6 month supply limit will be from the date of their August supply as this was after 1 July 2016). The NDSS Connect software will automatically calculate this period. After six months, the NDSS system will prompt that the registrant is no longer eligible to receive subsidised test strips and these registrants should be directed to speak to their health professional. This will be automatically recorded on the NDSS IT system accessed by pharmacies when supplying products to registrants. The initial six month access period applies to both new and existing NDSS registrants. Even where a registrant has been accessing test strips for several years, their six month initial access period will commence from their first order of test strips on or after 1 July 2016. A person will not need a medical authorisation for this initial supply. After six months, they will be eligible for subsidised test strips, if in the opinion of an authorised health professional (medical doctor, nurse practitioner, credentialed diabetes educator) their condition warrants the continued monitoring of blood glucose. Importantly, if a person needs access to subsidised blood glucose test strips for clinical reasons, they will continue to receive access after the required form is completed by a health professional. These restrictions do not apply to people who use insulin, people with a rare form of diabetes or women with gestational diabetes. 12. Why are the new restrictions on blood glucose test strips being implemented? The Pharmaceutical Benefits Advisory Committee recommended restrictions to access to blood glucose test strips based on research including the results of a Post Market Review on products used in the management of diabetes. This review found there was limited evidence that selfmonitoring of blood glucose improves blood glucose control, quality of life or long-term complications in people with type 2 diabetes who are not using insulin. As a result, the Pharmaceutical Benefits Advisory Committee recommended more targeted access to test strips for people with type 2 diabetes to ensure that patients are using the most appropriate products. The outcomes of the Post Market Review are available at http://www.pbs.gov.au/info/reviews/diabetes. 13. How do registrants access more blood glucose test strips after six months? Registrants with type 2 diabetes who are not using insulin, who have a clinical need for blood glucose test strips will need a signed form from a medical doctor, or authorised health professional for subsidised blood glucose test strips after the initial six months. Ideally this extension to access should be sought before the six month period expires. Ongoing access is based on the clinical judgement of the authorised health professional as to whether the patient benefits from additional monitoring and if they meet one or more of the following criteria: The person is taking a medicine which may adversely affect glycaemic control i.e. sulfonylureas; The person has an illness in addition to diabetes that may adversely affect glycaemic control; The person s diabetes is inadequately controlled; There is a clinical need for the person to self-monitor their blood glucose level; or There has been a change to the person s existing diabetes management within the previous three (3) months. There is no limit on the number of authorisations that may be obtained as long as the registrant continues to meet one or more criteria for extended access. Authorisation cannot be retrospective Pharmaceutical Society of Australia Ltd. I 4
and the six month period cannot be accessed in segments (that is, the six months cannot be put on hold and recommenced at a later time). An authorisation is valid for six months and when presented to a community pharmacy Access Point, it will grant the registrant six months of access to subsidised blood glucose test strips. A registrant can still purchase non-subsidised blood glucose test strips over-the-counter at any community pharmacy, at any time, without any restrictions. 14. Who are the authorised health professionals that can approve extensions for access to blood glucose test strips? Medical practitioners, nurse practitioners and credentialed diabetes educators. 15. Is there a form an authorised health professional needs to fill out for people to access blood glucose test strips? The initial six month supply of subsidised test strips starts from the first time a registrant buys products on or after 1 July 2016. An access form is not required for the initial supply. If the registrant requires an additional six months access, there will be a new authorisation form to grant a six month extension, available from the NDSS website, and will be similar to the current NDSS Change in Medication form. This will need to be downloaded and completed by an authorised health professional. This form should be provided to the person to take to the pharmacy. A registrant s eligibility to access blood glucose test strips will be recorded on the NDSS IT system used by pharmacies. When the period expires, the system will automatically record the registrant as ineligible and they will be directed to see an authorised health professional if they wish to obtain subsidised blood glucose test strips. 16. What do pharmacy staff need to do with the authorisation form? If a registrant is granted an additional six months access, they will need to bring the completed authorisation form to the pharmacy. Pharmacy staff will need to update the relevant details in NDSS Connect following the prompts. The system will automatically calculate the new six month period based on these details. It is important to note that extended access cannot be provided retrospectively and six month access periods are continuous and cannot be accessed in segments. An authorisation form is valid for six months, for example, an authorisation form dated 1 January 2017 is invalid after 1 July 2017. 17. What about people with other types of diabetes. Can they still access blood glucose test strips? Yes. Access to blood glucose test strips will not change for people with type 1 diabetes, type 2 insulin-dependent diabetes, gestational diabetes or those registered on the NDSS with a rare form of diabetes. They will continue to receive them subsidised under the NDSS. Pharmaceutical Society of Australia Ltd. I 5
18. Will blood glucose test strips remain listed on the Pharmaceutical Benefits Scheme (PBS)? Blood glucose test strips will be delisted from the Pharmaceutical Benefits Scheme (PBS) from 1 July 2016. Blood glucose test strips will remain available through the NDSS and people with diabetes will have continued access through the NDSS. Aboriginal and Torres Strait Islander people who are currently eligible for a lower co-payment, or no co-payment, under the Closing The Gap (CTG) arrangements will continue to receive similar subsidisation under the NDSS. 19. Will insulin pump consumables be available from community pharmacy Access Points? Yes. Insulin pump consumables will be available at the NDSS community pharmacy Access Point of a person s choice. Where the pharmacy does not have the IPC in stock, it can be ordered by and supplied to the pharmacy, usually within 24 hours. People will still be able to talk with experienced staff from Diabetes Australia on the phone (1300 136588) about IPCs. The NDSS information line will continue and operators can provide assistance. To assist IPC users with the changes, there will be a two month transition period that will allow registrants the option to purchase IPCs from their community pharmacy Access Point or by telephone through their state/territory diabetes organisation. This will continue until 31 August 2016. Postage charges for home delivery will apply to orders placed with state or territory diabetes organisations during this time. Orders can be placed via the NDSS information line on 1300 136 588. 20. Do Access Points need to stock all Insulin Pump Consumable (IPC) products? No. Access Points are not required to stock IPCs, as they may be ordered as required and delivered generally within 24 hours at no cost to the pharmacy. IPC users are being advised that Access Points may need to order IPCs on demand. 21. How are IPCs ordered? IPCs will be ordered on demand via NDSS Connect for delivery generally within 24 hours. Access Points will be able to see a registrant s IPC supply history to assist in ordering the correct product. IPCs cannot be ordered by a pharmacy until 1 July 2016. 22. Will pharmacy staff receive training? As part of the changes, pharmacy staff will receive information and education regarding IPCs, however, it is not expected that pharmacy staff will provide clinical advice to users regarding these products; they are only responsible for the supply of IPCs. Diabetes Australia will be providing Access Points with information on where to refer IPC users requiring additional clinical care. People will still be able to talk to Diabetes Australia with experienced staff on the phone (1300 136 588) about IPCs. The NDSS information line will continue and operators can provide assistance. Pharmaceutical Society of Australia Ltd. I 6
23. What advice can I give to IPC users who are enquiring about ordering stock? IPC users are encouraged to maintain a suitable supply of IPCs at all times. IPC users are encouraged to visit their pharmacy in early July and place their order, as required. Orders will generally be delivered within one working day. To assist IPC users with the changes, there will be a two month transition period that will allow registrants the option to purchase IPCs from their community pharmacy Access Point or from their state/territory diabetes organisation. This will continue to 31 August 2016. Where products are ordered by mail, registrants will be required to pay for postage. 24. Will the co-payment for diabetes products change? No. There are no changes to the co-payment or range of NDSS products. NDSS products will continue to be subsidised by the Government. There may be charges related to home delivery or postage if these are required. Pharmaceutical Society of Australia Ltd. I 7