We will update information we hear on FreeStyle Libre prescribing around Scotland
As for March 2018 only 3 boards have clear pathways and prescribing policies in place:
This leaves 11 boards who may have some patients using the Libre, but do not have a fair policy in place.
Numbers prescribed in November 2017 (We are unable to get figures more recent than 3 months behind)
Many people have had ongoing funding either through the clinic or special funding requests. We are trying to report on people now being prescribed the FreeStyle Libre since it became available on the drug tariff with factual information unlike the rumours in social media. It is early days, and everything takes time, for this reason, we don’t expect things to become clear until closer to the end of 2017. The good news is no board has given an outright no yet, unlike some CCG’s in England. Unfortunatly we now are hearing noes and long delays in decisions. (TBC) The North of Scotland do not expect a decision till July 2018.
For further information on CCG’s (Scotland is not accurate) See Diabetes UK’s map here
Boards around Scotland will likely base their local guidance on recommendation of the guidance by the Scottish Diabetes Group. See this here. Although Forth Valley, Borders and Lothian are the only boards to commence prescribing pathways (subject to local guidelines) there is talk of a possible National Guidance in Scotland. We will update as soon as more information is available.
Wales now says yes to flash glucose monitoring on a National basis
Northern Ireland has now approved a pathway for the Freestyle Libre for general use throughout the country. Correspondance has been made with all relevant parties with instruction to co-operate with the implementation of the access to the Libre.
For a pharmacy to dispense the Libre sensors, whether privately or on prescription, they must first register here:
Once registered they can order sensors which Abbott will deliver in around 24Hrs, so faster than ordering directly from Abbott. As the sensors are not yet on the system, if your GP is writing one, it will need to be handwritten for now.
Ayrshire and Arran
Positive news expected in March
Borders have commenced a prescribing pathway to eligible patients
19th February 2018 – Prescribing news and guidance expected very soon.
November 2017, Prescribing guidance is going through the national process for inclusion in local formulary. Draft guidance is sent to joint formulary for review before a decision will be made. No patients have yet been prescribed the Libre due to the inclusion on the drug tariff.
17th Nov – Borders peads prescribing if they feel it’s necessary.
Dumfries and Galloway
Not prescribing at this time.
January 2018 – Some adults and paedriatrics now getting prescriptions. Some are asked to sign a ‘contract.’ Which is committing to meet criteria for continued funding.
FreeStyle Libre was added to the Scottish Drug Tariff on 1st November 2017 with a qualification note stating that the product should not be initiated without reference to an appropriate diabetes specialist and in accordance with local guidance.
A subgroup of the Scottish Diabetes Group has developed guidance to help NHS Boards identify people who should be considered for NHS funded Flash Glucose Monitoring in Scotland. Currently, this Scottish clinical guidance states that Flash Glucose Monitoring should be considered in people who:
- Use intensive insulin therapy (multiple daily injections or continuous subcutaneous insulin infusion); and
- Agree to attend a locally provided Flash Glucose Monitoring education session; and
- Agree to scan glucose levels no less than six times per day; and
- Agree to share glucose data with their diabetes clinic; and
- Have attended a recognised diabetes structured education programme and/ or the clinical team are satisfied that the person (or carer) has required knowledge/ skills to self-manage diabetes.
This Scottish clinical guidance also states that “Continuing prescription for long-term use of FreeStyle Libre would be contingent upon evidence of compliance with the above conditions and that on-going use of the Freestyle Libre is demonstrably improving an individual’s diabetes care.”
NHS Forth Valley will consider the local position regarding FreeStyle Libre in due course, after formally reviewing guidance from NHS National Services Scotland, the full clinical guidance from the Scottish Diabetes Group and any other local factors.
In the meantime, we have advised local GPs that:
- The Forth Valley Diabetes Network will review the product to determine the most appropriate place in therapy and which patients this product will be suitable for, taking into account clinical guidance from the Scottish Diabetes Group.
- The Scottish Diabetes Group guidance indicates that Flash Glucose Monitoring should be considered in people who use intensive insulin therapy (multiple daily injections or continuous subcutaneous insulin infusion).
- The recommendation to commence FreeStyle Libre should originate from the local diabetes specialist team.
- Prescribing arrangements will be confirmed once local advice has been issued.
- In the meantime, patients receiving intensive insulin therapy should contact the specialist diabetes team at Forth Valley Royal Hospital if they have any further questions regarding Freestyle Libre.
The first 10 patients reported to have NHS funded prescriptions in Scotland to us (10th November 2017)
‘The pump clinic at NHS Forth Valley gave secondary care approval for Libre sensors. Passed to my GP yesterday and the prescription was written this morning! ‘
If you enquire Forth Valley are adding patients who meet the guidelines to a waiting list and advising someone will be in touch.
The MCN’s Libre criteria was approved by Forth Valley finance on 19th December 2017
Got a prescription?
The Larbert Pharmacy are registered to dispense Libre prescriptions and normally have some in stock or can order for you.
94, Main St,
Telephone: 01324 557596
This pharmacy normally has the Libre in stock ready to dispense, however if you are making a journey over it may be a good idea to call ahead to check.
For anyone in the area, this pharmacy comes highly recommended by customers for its helpful staff who will do anything to help and make collecting prescriptions a stress-free task!
MCN in process of building a business case to be sent for approval.
Message from Grampian Type 1 Diabetes Community Group
We have been contacted by the Grampian Diabetes Clinic to ask for patient testimonials on the use of Freestyle Libre. If you are interested in contributing your testimonial to the clinic, please contact firstname.lastname@example.org and we will send you full details. Please do not send us your testimonial, we’ll tell you where to send it.
*** Deadline 4th Dec 2017 for testimonials.
Greater Glasgow and Clyde
Draft guidelines/criteria from the MCN are being sent to the Health board for approval. Prescribing will be available to those who meet the guidelines and GG&C are keen to keep prescribing consistent for anyone meeting criteria.
A patient has said they are now funded (This is unverified)
15th Nov – More reports of funded patients – However full guidance still not approved. Prescribed on an individual and case-by-case basis.
Buying sensors yourself?
New Life Pharmacy
665 Clarkston Road
Telephone: 0141 637 6000
Are selling at a very reasonable cost with a small handling charge.
Hand Pharmacy Whiteinch will order for you, cost £42
1239, Dumbarton Road
Telephone: 0141 959 9150
Same for Hand Pharmacy Partick
510, Dumbarton Road
Telephone: 0141 334 2268
Lloyds Pharmacy have been selling at various prices from £42-£57.95* I am still waiting on cost confirmation from Lloyds
Boots on Great Western Road (Nr Byres Rd) are charging a £20 handling fee and want a private prescription.
The Libre is not available for prescription in NHS Highland at present. They are building a business case with a view to making a local formulary submission. No timescale available.
Positive news expected in March
January 2018 – Following a period of discussion across all Scottish Health Boards and Diabetes Services, national guidance and criteria for the use of the Freestyle Libre is in the process of being agreed. It is likely that the guidance will outline clear criteria that patients will be expected to meet before they can access Freestyle Libre sensors on prescription. NHS Lanarkshire intends to adopt the national guidance once it has been finalised, although at this point we do not have a date for when this will be.
A patient has said they are now funded (unverified)
Freestyle Libre, a flash glucose monitoring device, was added to the Scottish Drug Tariff on 1st November 2017. The entry in the tariff stipulates that initiation of Freestyle Libre should be following assessment by an appropriate specialist in the treatment of diabetes mellitus and in accordance with local guidance.
Development of local guidance is underway with NHS Lanarkshire diabetes consultants and this will be evaluated and ratified through the standard Lanarkshire Board processes once complete.
Until this process is complete there should be no initiation of prescribing by either Primary or Secondary care clinicians.
UPDATE 7th February 2017
“The committee agreed to classify Freestyle Libre as routinely available. Included on the Lothian Joint Formulary, for Specialist initiation only.”
This is the latest from the Lothian Joint Formulary which appears to state that the Freestyle Libre is now routinely available on prescription from your Specialist Diabetes team.
For the most up to date FreeStyle Libre statement please see The Lothian Diabetes website.
UPDATE (JANUARY 3rd 2018): The Lothian formulary committee considered the Freestyle Libre at its meeting on 13th December. Although they have provisionally approved its use, there is a lack of clarity over the mechanism for initiating the Libre, which needs to be resolved before it can be prescribed. The committee has therefore been asked to reconsider the position at its next meeting on 24th January. It will not be possible to provide any further detail until after this meeting and the formulary committee may take up to two weeks to inform us of their decision. It will not be possible to prescribe the Freestyle Libre sensors until after the next formulary committee meeting.
#FreestyleLibre is not currently available on prescription in NHS Lothian. A submission will be made to our local formulary committee and a statement will be issued once a decision is made. We cannot confirm any timescale at present.
Buying sensors yourself?
Ian Brown at Colinton Pharmacy in Edinburgh will order and sell sensors for £35 plus £5-£10* fee per order. They have the forms to sign for VAT exemption available.
Telephone: 0131 441 2352
Fleming Pharmacy are selling at £42*
131 Liberton Brae
Telephone: 0131 658 1274
Roslin Chemist & Pharmacy are selling at £42*
122 Penicuik Road
Telephone : 0131 440 2596
The clinical team have drafted a planned approach for how they will take this forward with a paper due to be presented to their senior management team before Christmas which will allow them to make a decision and plan for a phased pilot early in January.
February 2018 – latest update here and unfortunately not what patients were hoping to hear. The decision was not made at the Prescribing Management Group.
NHS Tayside is to await the outcome of a Scottish Health Technology Appraisal of FreeStyle Libre to help inform a policy position for its use. This position is likely to be available in mid – late summer 2018. Until that position is developed and agreed Freestyle Libre will not be available on prescription in NHS Tayside. Further information on the availability of Freestyle Libre will be made available at that time.
The final decision around the clinical and business case for use in NHS Tayside will be at the Prescribing Management Group in February 2018. We should hear shortly after this.
8th November 2017 – Patient reported ‘We were told that they expect to be able to give this on prescription within 4-6 weeks, it is already available to prescribe but the paperwork element is further behind.’
10th November via a patient – The consultant told me he had ‘good news’ for me. There had been a meeting of the Managed Clinical Network yesterday and the libre would be funded. He said Ninewells are collating names of people at the moment and would be in contact once they knew it was going ahead.
He said the GP would need to prescribe but to hold off contacting them yet as they will not have received the go-ahead yet.
More news as we get it….
1 patient confirmed full-time Libre funding today (still 10th Nov)
* Prices correct at time of writing but can change at any time.
Data is 3 months behind, so the most recent data we have is from December 2017
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