How to Access Medtronic/MiniMed Funding Through the Exceptional Circumstances Pathway

Access to any funded Medtronic/MiniMed products will require approval through Pharmac’s Exceptional Circumstances pathway.  Pharmac acknowledges the funded options going forward might not be suitable for everyone and will consider funding for Medtronic/MiniMed insulin pumps and Continuous Glucose Monitoring (CGM) through the Exceptional Circumstances pathway, allowing patients to apply on a case-by-case basis.

If switching to a funded pump isn’t clinically appropriate, or the funded options haven’t worked for you, your healthcare provider can assess whether an Exceptional Circumstances application may be appropriate.

To Access Funding:

Your diabetes specialist team/provider must provide the following evidence to Pharmac:

• The clinical reasons why the funded brand won’t work for you.
• The clinical reasons you need to remain on your current Medtronic/MiniMed CGM and/or insulin pump.

Pathway to Diabetes Technology Alternative Brand Allowance (ABA)

An ABA application may allow access to an alternative brand of diabetes technology when applying for:

• Insulin pump and insulin pump consumables.
• CGM, insulin pump and insulin pump consumables to create an automated insulin delivery system (AID).
• Continuous Glucose Monitoring (CGM).

For details on Pharmac’s Exceptional Circumstances criteria, see the Diabetes Technology ABA Application Form

Summary

ABA funding may be considered for people who meet the eligibility criteria for funded diabetes technology but cannot use the funded options due to their individual circumstances, including:

• Significant cognitive impairment or physical disability that makes changing to and learning a new listed device difficult without support. (Note, this would be considered in situations where the individual does not have a support person who would be able to facilitate a change to a listed insulin pump and insulin pump consumables.).
• Complex social circumstances where the listed option does not meet the person’s clinical needs.
• Clinical circumstances where the listed insulin pumps and consumables are not considered clinically appropriate in the opinion of the treating clinician.
• For CGM-only applications, where the listed funded CGM options are clinically inappropriate for the individual.

Did you know

Pharmac has also increased the consumable allowance for infusion sets and reservoirs. Specifically, the limit has been updated to the following quantities every 3 months per prescription:

• A maximum of 5 boxes of infusion sets
• A maximum of 9 boxes of reservoirs

This change may help you better manage your supplies. Discuss access with your healthcare professional when requesting a new prescription.

With the new funding regulations placing resource strain on diabetes clinics and creating longer wait times for clinical support, many people are also seeking advice from private providers. Both public and private healthcare providers can support eligible patients in continuing to access Medtronic/MiniMed insulin pumps and consumables.

We’re Here to Support You

We understand these funding changes may create uncertainty for many Medtronic/MiniMed users and families. Medtronic and InterMed are committed to supporting our New Zealand diabetes community and will continue to be present in the market for those who rely on our technology.

Our team is here to help guide you through the Exceptional Circumstances application process, answer any questions you may have, and provide information and resources to support discussions with your healthcare team. If you are unsure about your options or need assistance understanding the funding pathway, please don’t hesitate to reach out.

We would like to sincerely thank you for your ongoing trust and support. We highly value you as a customer of both InterMed and Medtronic and remain dedicated to helping you achieve the best possible outcomes in your diabetes management journey.

If you require support or have any questions, please contact the InterMed team. We are here to help. Email genevieve@intermed.co.nz.