For most diabetics, the gold standard test for their disease is the Blood glucose serum test (BGST) which measures the level of glucose in their blood, and acts a measure of their control of the disease.
This test is done, mostly by themselves, by placing a drop of blood onto a reagent test strip which is then read by a glucometer, which gives a reading of the concentration of glucose in mmol/l.
As diabetes is a chronic long term condition, this testing is funded by the HSE for all diabetics, either through the medical card or LTI scheme.
The cost of this testing has been growing steadily over the past decade and now totals over €40m annually.
The HSE asked the MMP (medicine management programme) to look at this sector to extract some efficiencies, as the disease continues to grow in Ireland and across the developed world.
The HSE has access to huge amounts of data generated by the PCRS system, and it found that over 90% of the strips being used cost more than €20 per pot, despite the fact that there were plenty of lower priced strips at exactly the same quality, but very little market share.
The MMP investigation revealed that three large players had dominated the market for over 10 years and there was little incentive for prescribers to change their habits.
So, in early 2020, the HSE started a consultation with stakeholders to see if they could get better value for this testing service.
They spoke to patients, doctors, pharmacists and companies who supplied the systems, and determined that there was plenty of room for improvement from their perspective as payers.
They had reached their conclusions by Spring 2020, but the pandemic intervened, and so have only just announced their programme of ’preferred test strips’ in January 25, 2021, and published on January 28.
Their conclusion is that a list of 10 test strips, all below €15 per pot, will serve the market perfectly well, and that there are adequate supplies of the meters required to read these ten strips, and to cater for all types of patients. This should save the HSE more than €30 million annually, and the task now is to convert the market from a choice of 35 different strips to these ten preferred strips.
The intention is to write to all prescribers and dispensers of BGTS, identifying these strips and encouraging a switch.
They will also consider a requirement of online justification for prescribers not switching their choice of strip to explain why they want to continue using an expensive strip, to aid in compliance.
A key factor in this sector is the availability of meters, and these are provided by the companies (normally free of charge) to clinics, GPs and patients themselves.
Some of the strips included have no presence in Ireland and attempt to cover the market from the UK. Other such as Windzor Pharma, have both meters and stock readily at hand in Ireland and a sales team to support the product.
They have two strips in the preferred list, Nexus and HCT glucose test strips.