Navigating the Diabetes Technology Alternative Brand Allowance (ABA)

This is a guide for clinicians to accessing funding on behalf of their patients for alternative (usually non-funded) diabetes technology, with special consideration for the Medtrum Nano patch insulin pump as a solution for individuals managing sensory issues, trauma, or other mental health challenges alongside their diabetes.

The Alternative Brand Allowance: An Overview

• Pharmac provides access to funded continuous glucose monitors (CGMs) and insulin pumps for eligible individuals living with type 1 or type 3c diabetes. The current funded insulin pumps are the Tandem t:slim x2 and the mylife YpsoPump.

• However, Pharmac acknowledges that the funded options may not be clinically suitable for everyone. For these individuals, the Alternative Brand Allowance (ABA) provides a pathway to obtain funding for a different device.

• The process is different to a Named Patient Pharmaceutical Assessment (NPPA). It is more streamlined and doesn't require as much detail. However, evidence of a genuine clinical need beyond personal preference is still essential when applying for the ABA. 

• The form to be completed by the treating clinician can be found here.
  
  

Who is a Candidate for the Alternative Brand Allowance?

 An application for an alternative device may be considered if a patient's clinical circumstances mean the funded options are not appropriate. This can be particularly relevant for individuals who experience significant challenges with the physical or psychological aspects of wearing a traditional tubed insulin pump.

The key criteria for an ABA application, as outlined by Pharmac, include situations where:

• The individual has a significant cognitive impairment or physical disability that makes it difficult to learn and use the funded insulin pumps.

• The individual has extremely difficult social circumstances where the funded pumps are inadequate to meet their clinical needs.

• In the opinion of the treating clinician, the funded insulin pumps are not clinically appropriate due to the individual's specific circumstances.

This last point is crucial for patients with sensory processing disorders, a history of trauma, or other mental health conditions that can be exacerbated by the constant physical presence and demands of a traditional insulin pump.

The Medtrum Nano Pump: A Potential Solution for Specific Needs

The Medtrum Nano is a tubeless patch insulin pump that presents a viable alternative for individuals who struggle with the sensory or psychological burden of conventional pumps. Its discreet design and lack of tubing can offer significant benefits for patients with:

• Sensory Issues: For individuals with sensory processing disorders, autism spectrum disorder, or a heightened sensitivity to tactile stimuli, the constant presence of tubing can be a source of irritation, anxiety, and distress. The small, lightweight, and tubeless design of the Nano pump can significantly reduce this sensory load.

• Trauma: For patients with a history of trauma, particularly that involving medical procedures or a feeling of being tethered, the tubing of a conventional pump can be a constant and unwelcome physical reminder. The freedom from tubing offered by a patch pump can contribute to a greater sense of bodily autonomy and psychological comfort.

• Mental Health Challenges: Living with diabetes is already associated with a significant mental health burden. For those also managing conditions such as anxiety, depression, or body image issues, the visibility and physical intrusion of a traditional pump can be an additional stressor. The discreet nature of the Nano pump can help to reduce feelings of self-consciousness and the constant visual reminder of their condition.
  
  

Writing a Compelling Clinical Justification for an Alternative Brand

When applying for an ABA for a device like the Medtrum Nano, a clear clinical justification is paramount. The application must articulate clearlywhy the funded options are not clinically appropriate for the specific patient.

Your justification should include:

1. A brief overview of the patient's clinical and psychosocial history. This should detail their diabetes management, as well as any relevant diagnoses of sensory processing disorders, trauma-related conditions, or other mental health challenges.

2. Specific examples of how the funded pump options would be detrimental to the patient's physical and/or mental wellbeing. This could include:

   • For sensory issues: Detail how tubing would cause significant distress impacting their ability to consistently wear the device.

   • For trauma: Explain how the physical tethering of a tubed pump is a trigger anxiety or post-traumatic stress responses.

   • For mental health: Describe how the visibility and physical presence of a traditional pump would exacerbate anxiety, body image issues or disordered eating patterns.

3. A clear rationale for why the proposed alternative (e.g., the Medtrum Nano) mitigates the factors that make a funded tubed pump clinically unsuitable. Highlight the specific features of the device, such as its tubeless design, small size, and discreetness, and directly link these to the patient's unique needs.

4. An explanation of how the proposed device is expected to improve clinical outcomes and/or quality of life. This could include better glycaemic control due to access to Automated Insulin Delivery, reduced psychological distress, and greater engagement in self-management.

5. Attached evidence. Include evidence of any relevant diagnosis. This could be in the form of a letter from a paediatrician or treating psychologist confirming the factors for the patient and supporting the solution proposed by the treating clinician. 
   
   

The Application Process

Applications for the Alternative Brand Allowance are made by the treating clinician on behalf of the patient. The application form can be found on the Pharmac website here. The form should be completed and emailed to nppa@pharmac.govt.nz along with the supporting evidence described above. You will need to list the details of the device being requested. You can find Pharmacodes for the Medtrum Nano listed below.