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A response to our CMS appeal to make sensor technology a PMB for Type 1s

It has taken over a year, but the Council for Medical Schemes (CMS) has finally responded to our appeal to make sensor technology a Prescribed Minimum Benefit (PMB) for Type 1s in South Africa.

A half-hearted CMS response

Don’t get excited, it’s not good news. It feels a little like they are fobbing us off – after finally (finally!) reading our appeal, they have come back saying there’s not enough evidence for sensor technology being better than fingersticks.

More precisely:

In the absence of evidence confirming that the blood glucose test strips currently funded by medical schemes are not cost-effective nor evidence based, we are not in the position to issue a general directive to medical schemes and their administrators to fund a specific device as PMB level of care.

Council for Medical Schemes

They added this in, which is important to note while we appeal:

We will however adjudicate on individual complaints received and consider the clinical merits of each case thereof. A member of a medical scheme is therefore welcome to lodge a complaint with our office whereupon same will be adjudicated on the clinical evidence presented.

Here’s how to complain to the CMS.

You can read the entire response by downloading it here:

So what happens next?

We appeal, of course.

NICE (the National Institute for Health and Care Excellence) is the tax-funded regulatory body in the UK who determines what measures are cost-effective. They have determined that all Type 1s should have access to CGM (Continuous Glucose Monitoring). And they have 200+ pages of evidence review to prove that it is cost-effective, and (more importantly for us!) better for people with diabetes.

How can you help with our CMS appeal?

This Section 47 complaint is specifically centered on the fact that not offering sensor technology causes harm to people with Type 1 diabetes. (You can read about the appeal in full here.) So many of you submitted your stories – we sent in 47 pages of testimonials and a petition with over 14,000 signatures. Thank you!

But now we need specifics.

We are looking for examples of Type 1s whose medical aids have declined CGM, and as a result they have suffered harm or similar negative results and have proof of that.

If this is you, please email with details – we will need your name, medical aid name, and details of what happened.

Taking the long view

Within the next few years, all South African medical aids and the public sector will offer sensor technology to people with Type 1 diabetes – and to those with Type 2 diabetes who need it.

It will take time, and negotiation with the manufacturers to drop the prices, and there will be guidelines to follow, but it will happen. We just have to take the next logical step – which is exactly what we’re doing.

Interested in diabetes advocacy?

If stuff like this makes you excited, please sign up for our free Diabetes Advocacy course on SA Diabetes Advocacy. We need as many empowered South African diabetes advocates as we can get!

What to read next?

We did it! How to claim the Discovery CGM Benefit: A step-by-step guide to claiming the CGM Benefit.

What is a CGM? All the details you need to understand how Continuous Glucose Monitoring and Flash Glucose Monitoring works.

How to claim CGM from your medical aid: It might seem as if there aren’t that many options to claim CGM (Continuous Glucose Monitors) or flash glucose monitors (like the FreeStyle Libre) from your medical aid, but that’s simply not true. Here’s how to claim CGM from your medical aid.

Photo by Markus Spiske on Unsplash

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Sweet Life is a registered NPO/PBO (220-984) with a single goal: to improve diabetes in South Africa. We are funded by sponsorships and donations from aligned companies and organisations who believe in our work. We only share information that we believe benefits our community. While some of this information is linked to specific brands, it is not an official endorsement of that brand. We believe in empowering people with diabetes to make the best decisions they can, to live a healthy, happy life with diabetes.