Cost of Looping Consumables? (Pump and Sensor)

[VincentSaelzler]

I would like to use this looping setup:

• Tandem t:slim insulin pump
• Dexcom G6 sensors

How can I find out the cost of consumables?

• G6 sensors
• t:lock cartridges
• VariSoft infusion sets

A bit of background: I live in the US, and plan to move to London early next year.

• I currently use an old Medtronic pump and G6 sensors (not looping).
• I have the opportunity to purchase another pump before leaving.
• The t:slim and G6 combination looks like the best option

Alternatively, is another looping setup significantly more cost-effective for ongoing supplies?

Thanks in advance for any assistance! 🙂

 

[everydayupsanddowns]

The only item I know you can buy on your list is the Dexcom G6, which works out at approx £50 per sensor (10 days), and £200 (90-120 days.

I am not sure if you can buy the pump and consumables, as payment seems to be limited to NHS trusts?

Will you be able to access NHS services while you are here? How long are you staying?

 

[VincentSaelzler]

The only item I know you can buy on your list is the Dexcom G6, which works out at approx £50 per sensor (10 days), and £200 (90-120 days.

That is valuable information! Thanks.

I am not sure if you can buy the pump and consumables, as payment seems to be limited to NHS trusts?

I will purchase the pump itself in the US.
A lack of access to compatible pump consumables in the UK would be an issue.

Will you be able to access NHS services while you are here? How long are you staying?

I will have NHS access, and plan to say for 3 years.

 

[everydayupsanddowns]

If you’ve been able to get a pump prescribed, you may be able to get consumables funded on the NHS, though I confess I don’t know the intricacies of getting that organised.

If you know where you are likely to be based, perhaps you could contact the local hospital and ask the Endocrinology department for advice?

 

[VincentSaelzler]

Okay, I will check with the local hospital's endocrinology department.

Thanks for all of your prompt replies and insight!

I noticed from your signature and blog that you are on the TSlim/G6 setup. I hope that continues to work well for you, and that I join you with that setup soon! 🙂

 

[42istheanswer]

That is valuable information! Thanks.


I will purchase the pump itself in the US.
A lack of access to compatible pump consumables in the UK would be an issue.


I will have NHS access, and plan to say for 3 years.

I would assume that once you have the relevant IHS number, your NHS access would be exactly the same as ours. Which would mean that your pump consumables would be free as with diabetes requiring medication you can get a medical exemption certificate from paying prescription charges. https://www.nhs.uk/nhs-services/prescriptions-and-pharmacies/who-can-get-free-prescriptions/

It would almost certainly be easier to get them prescribed promptly if you can speak to the Endocrinology department prior to arrival and make sure that you can get a prompt referral in. But if you ran out much earlier than anticipated for some reason and didn't yet have GP and specialist referral set up, then if you contacted NHS 111 (you can just call 111 from a phone in the UK) they would be able to advise you how to get urgent help to get a prescription in the area where you will be living/staying, whether that is via "out of hours" GP services or whether they sent you to A&E (ER).

It is also possible to get private prescriptions in the UK, but I don't know how the cost of those is worked out - it is likely to be more than the "cost to the NHS" stated in the BNF (British National Formulary) as I don't think that includes the costs of the pharmacist actually dispensing the prescription, and of course the doctor prescribing would charge a fee as well. And I don't think you should need to go that route.

 

[VincentSaelzler]

you can get a medical exemption certificate from paying prescription charges

Thanks for that info!

That helps clarify how the system works for someone coming from the US.

 

[helli]

Which would mean that your pump consumables would be free as with diabetes requiring medication you can get a medical exemption certificate from paying prescription charges.

In my experience, pump consumables are funded differently. Whilst insulin and test strips are prescribed by the GP and picked up from the pharmacist, this is not the case with pump consumables and CGM (with the exception of Libre). Pump consumables are provided on a contract between the pump manufacturer and diabetes clinic, which in my case is at the local NHS hospital. The pump consumables are sent directly to my home address. In my experience, pharmacists have not knowledge of insulin pumps and consumables.
Whether you are entitled to a pump and pump consumables, appears to be a decision made by the diabetes clinic and varies by CCG. It is far far more complex (and postcode lotteried) than a simple case of getting a medical exemption certificate for your prescription.

 

[42istheanswer]

In my experience, pump consumables are funded differently. Whilst insulin and test strips are prescribed by the GP and picked up from the pharmacist, this is not the case with pump consumables and CGM (with the exception of Libre). Pump consumables are provided on a contract between the pump manufacturer and diabetes clinic, which in my case is at the local NHS hospital. The pump consumables are sent directly to my home address. In my experience, pharmacists have not knowledge of insulin pumps and consumables.
Whether you are entitled to a pump and pump consumables, appears to be a decision made by the diabetes clinic and varies by CCG. It is far far more complex (and postcode lotteried) than a simple case of getting a medical exemption certificate for your prescription.

Presumably the direct cost to you as the consumer is the same though (zero)? (Obviously indirectly we all pay towards it through NI and tax)

 

[VincentSaelzler]

It is far far more complex (and postcode lotteried) than a simple case of getting a medical exemption certificate for your prescription.

Bummer. Thanks for the info though! 🙂

Interestingly, that's about how it works in the US.

• Insulin and test strips are filled as prescriptions.
• Pumps, reservoirs, infusion sets are "durable medical equipment" from a mail order vendor.
• CGM sensors are sometimes ordered like prescriptions, and other times ordered as "durable medical equipment"

Is there a way to read reviews about the services offered in different postcodes? I don't have a specific flat picked out yet, so that could be a consideration in picking one.

 

[helli]

Is there a way to read reviews about the services offered in different postcodes? I don't have a specific flat picked out yet, so that could be a consideration in picking one.

I am not aware of such a thing.
To be honest it is not necessarily about the quality of service offered but about the way the NICE guidelines are interpreted by each CCG and how they chose to spend their budget. For example, some may chose to offer more pumps whereas another may chose to offer less pumps but more closed loop. The other thing to consider is that different clinic offer different insulin pumps. Some clinics offer a large choice and others only offer a very small choice ... again it is how they chose to spend their budget including the costs of training the DSNs.

My advice would be to familiarise yourself with the NICE (National Institute for Health and Care Excellence) guidelines for an insulin pump and Type 1 diabetes management. This is invaluable for understanding how the decisions are made are building your case for why the NHS should fund a pump for you.

 

[helli]

Presumably the direct cost to you as the consumer is the same though (zero)? (Obviously indirectly we all pay towards it through NI and tax)

True but the decision making is different. Everyone with Type 1 diabetes is provided with insulin, test strips, etc. I believe it is something like only 20% have funding for insulin pumps with far less having access to closed loop.
The diabetes clinic we attend dictates whether we meet the criteria for insulin pumps and decide which pumps are available.

 

[rebrascora]

I am wondering if it might be a good idea to find a clinic which offers support with the Tslim, because if you already have the pump and need consumables and the clinic you are referred to, do not have a contract and trained staff for the Tslim pump, then it isn't going to be helpful to you. For instance, my clinic only use Medtronic pumps I believe, so that wouldn't be any good to you and I imagine trying to get the CCG (or whatever the new name for them is) to fund consumables for the Tslim might be a tricky and time consuming process (months or years even in the current climate!) So if Tslim is your chosen pump and you are going to get that set up before you leave the states, then find an area to live which has a clinic which supports Tslim pumps. I am not sure if this can be done through an online search and may end up becoming quite convoluted as each area seems to have different information on their site. I wonder if you post a thread on the forum asking where Tslim users are based, it might short cut the process. Even if people don't want to reveal their geographical location publicly, you should be able to PM (Private Message) any respondents for their clinic details to see if any are within a reasonable distance of your proposed move.

 

[Thebearcametoo]

At least in theory any new clinic should provide like for like care so if you’re already on a pump they should continue it - this is part of the reasoning our paediatric team likes to have funding approved for kids so it makes it easier rather than waiting until they’re older and trying to get funding that way.

Depending what visa you are on you will have to pay the NHS surcharge for that visa - there are annual figures of £470/year for students and £624/year for adults but you need to pay for the whole of your visa period. That gives you an NHS number and from then on your care will be under the same conditions as UK residents so as people have said that would mean self funding a dexcom but your pump consumables and insulin etc being free on prescription/contract.

If for any reason you can’t get the consultant to sign off on continued use of a tslim then there are private options but it shouldn’t come to that.