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CGMs to be considered a "medical necessity" under USLaw...

Discussion in 'Type 1 Diabetes' started by tim2000s, May 16, 2016.

  1. tim2000s

    tim2000s Type 1 · Expert
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  2. AndyS

    AndyS Type 1 · Well-Known Member

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    All a very interesting read though the systems can't really compare and I don't see the NHS taking any real notice of this kind of ruling, when it happens.
    The US system is broken in its own way but then so is the NHS, in its own way.

    My own feeling on this is that until a proper closed loop system drops that shows a major quantitative improvement in treatment effectiveness we will not see any real changes in NHS attitudes. Obviously the CGM is a foundational component of such a system. I guess all in all it mostly comes down to scale more than anything to get the costs down and in that we have the proverbial chicken & egg situation.

    All that being said there are a number of non-invasive or minimally invasive CGM systems that seem to be really close to release so hopefully the additional competition the market will force a change.

    /A
     
    • Optimistic Optimistic x 1
  3. tim2000s

    tim2000s Type 1 · Expert
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    What would you consider would demonstrate this?

    It depends on your point of view. In the UK we give money to the government that funds the single, non-competitive health insurance scheme which is then used to fund care and dictates what you can and can't buy with it.

    In the US, you pay directly (a lot more) to a commercial organisation that provides you with the insurance and dictates what you can and can't buy with it.
     
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  4. BeccyB

    BeccyB Type 1 · Well-Known Member

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    I won't be holding my breath for a change here but something like this can only be a good thing. It might just bring a change a little closer for us
     
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  5. AndyS

    AndyS Type 1 · Well-Known Member

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    Me personally it would be out right data, some of which I assume probably exists from previous studies though since the artificial pancreas isn't really an in production reality at this stage. Of course it doesn't really count what would convince me (no convincing required) it is the policy makers in the NHS that would need the cold hard facts and obvious cost savings rammed down their throats.

    I accept your comparison of the two systems, admittedly I had never really considered it that way. But on the flip side with the UK system if you are critically ill or have a long chronic condition you don't have to worry about how you will pay your bills when you hit the upper limits of your insurance (yes I know there are different ones that maybe don't have that). So at least for us here we don't ever have the scary situation where we risk losing our home to pay for hospital bills.

    Interesting viewpoint you brought though ;)

    /A
     
  6. TorqPenderloin

    TorqPenderloin Type 1 · Well-Known Member

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    Hitting the "Upper limit" of an insurance plan in the US is a good thing. It's known as the "Maximum out of pocket" and it's capped at no higher than $6850 for individuals ($13.7k for families) in 2016.

    After paying that amount in out of pocket costs, the insurance company pays 100%. Note: that figure does not include the monthly premiums to be covered under a plan.

    As far as getting CGMs approved for Medicare, it's getting traction but still nowhere near resolved.
     
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