Pay for insulin in England
1. The most important things in a nutshell
Diabetics need numerous aids, e.g. blood glucose meters and disposable syringes. The additional payments for this depend on whether the aids are "intended for consumption" or not.
A basic distinction is made between “not intended for consumption” and “intended for consumption” when it comes to aids. The co-payment is calculated differently for the two categories.
2.1. Aids not intended for consumption
In the case of diabetics, this includes e.g. blood glucose meters, lancing devices, insulin pumps, insulin pens, pump bags and straps.
The additional payment amounts to 10% of the cost of the aid, but at least 5 €, at most 10 €, but in no case more than the cost of the aid itself.
The additional payment for non-consumable aids can be a burden for diabetics, especially at the beginning, since then, as a rule, extensive initial equipment is required.
2.2. Consumable resources
In the case of diabetics, this includes e.g. lancets, needles for insulin pens, cannulas, disposable insulin syringes, insulin pump consumables (catheters, adapters, ampoule sets, etc.).
The additional payment is 10% of the sales price. There is no minimum additional payment, the maximum additional payment may be € 10 per month for all aids intended for consumption.
3. Product groups
Aids are listed in aids lists, which are divided into product groups. Two product groups are important for diabetics:
Product group 03 application aids: Needles for insulin pens, cannulas, disposable insulin syringes
Product group 21 Measuring devices for body conditions / functions: Lancets for the lancing devices for taking blood
Even if a diabetic is prescribed "consumable aids" from different product groups or as a result of another illness, he must pay a maximum of 10 € for the consumable aids in one month.
4. Blood sugar and urine test strips
Blood sugar and urine test strips can be prescribed by the attending physician at the expense of the health insurance company if they are indicated.
Blood sugar test strips can only be prescribed if the blood sugar measurement is "economical and sensible". The patient must document the measured values and he must be able to draw therapeutic conclusions from them. The results are discussed with the attending physician every quarter.
4.2. Prescription of blood sugar test strips
How many blood sugar test strips can / should be prescribed by the doctor depends on the Association of Statutory Health Insurance Physicians. Some leave this the responsibility of their doctors, others give guidelines and recommendations. The health insurance company provides individual information.
5. Systems for continuous glucose measurement
Measuring systems for continuous glucose measurement or CGM for short (from “Continuous Glucose Monitoring”) are a newer method. They help to have the glucose process better under control and to be able to counteract an increase and decrease in blood sugar in good time.
These measuring systems consist of 3 components: a sensor, a transmitter (also called a transmitter) and a receiving device. The sensor is stuck to the stomach or upper arm. A sensor thread is connected to it, which is inserted into the subcutaneous fatty tissue with a setting aid. The sensor thread measures the sugar content in the tissue fluid at short intervals.
The sensor can also be worn while showering, bathing or swimming and must be replaced every 6 to 14 days, depending on the system.
5.1. Assumption of costs
The sensor measuring systems are included as aids in the service catalog of the statutory health insurance companies. The costs will not be covered in every case. The attending physician issues a prescription, and the patient and the physician must also submit an application to the health insurance company to cover the costs. The health insurance company checks and decides on the application.
6. Aids for erectile dysfunction
With diabetes, the risk of erectile dysfunction (impotence) is increased. One of the possible therapeutic measures is a vacuum erection aid, also called a vacuum pump. This is a clear plastic cylinder that slides over the penis. A pump creates a negative pressure so that blood flows into the erectile tissue. If the erection is sufficient, a suction ring prevents the blood from flowing back.
The vacuum erection aid is listed in the aid directory (product group 99.27.02) of the statutory health insurance and can be covered by the health insurance. A medical prescription is required.
7th practical tip
Does a patient need aids for taking blood or for injections (e.g. blood lancets) and the aid can only be used with the help of another person and There is an increased risk of infection (e.g. in people with HIV), there is a right to a stab-proof aid.
8. Related links
Diabetes> Erectile Dysfunction
Diabetes> Financial Aid
Diabetes> Behavioral Tips
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