Resources issued to help FreeStyle Libre formulary inclusion
A national group representing diabetes consultants in the UK has issued resources to help healthcare professionals to get FreeStyle Libre onto their formulary.
FreeStyle Libre became available on prescription across the UK from November 1, 2017, subject to local health economy approval, but fears of a “postcode lottery” have emerged.
In response, the Association of British Clinical Diabetologists (ABCD) has shared items to support the local adoption of the technology. The resources include:
- a supporting covering letter
- information to help a formulary case
- NICE advice on the newly approved device
- a Diabetes UK consensus guideline for flash glucose monitoring
Meanwhile, NHS England’s Regional Medicines Optimisation Committee (RMOC) has issued a position statement about FreeStyle Libre, with advice aimed at Area Prescribing Committees.
The RMOC recommended that Freestyle Libre should only be used for people with type 1 diabetes, aged four and above, attending specialist type 1 care using multiple daily injections or insulin pump therapy, who have been assessed by a specialist clinician and deemed to meet one or more of the following:
- Patients who undertake intensive monitoring >8 times daily
- Those who meet the current NICE criteria for insulin pump therapy (HbA1c>8.5% (69.4mmol/mol) or disabling hypoglycaemia as described in NICE TA151) where a successful trial of FreeStyle Libre® may avoid the need for pump therapy.
- Those who have recently developed impaired awareness of hypoglycaemia. It is noted that for persistent hypoglycaemia unawareness, NICE recommend continuous glucose monitoring with alarms and Freestyle Libre does currently not have that function.
- Frequent admissions (>2 per year) with DKA or hypoglycaemia.
- Those who require third parties to carry out monitoring and where conventional blood testing is not possible.
The statement said that until further trial data was available, it recommended that audit data on the use of Freestyle Libre® be collected through its use in limited and controlled settings where people attended care for type 1 diabetes.
It added: “The RMOC is aware that clinics using Freestyle Libre® are already collecting audit data and would strongly support all clinics to work collaboratively (potentially through the Association of British Clinical Diabetologists) to maximize learning about this new intervention and measure its impact in individual patients.”
The system automatically reads glucose levels through a sensor, approximately the size of a £2 coin, worn on the back of the upper arm for up to 14 days, eliminating the need for routine finger pricks and user calibration.
There has been a surge in demand for universal access to the technology on prescription after Abbott announced in September that it would be available on the NHS subject to local business cases.
An ABCD representative said: “We know that this has been a hot topic recently and we hope these documents will prove useful in trying to prevent any postcode lottery in access to this device.”
ABCD said: “Wholesale switching from capillary blood glucose monitoring would place an unaffordable burden on budgets at current prices, although the anticipated introduction of similar technologies should drive prices down and eventually consign inconvenient and painful finger prick glucose testing to history.
“Although FreeStyle Libre has been available to purchase directly from Abbott for some time, we want to avoid substituting access based on the ability to pay with a ‘postcode lottery’ across the UK whereby different areas apply different eligibility criteria.”