Will insulin analogues for children no longer be free of charge in Germany?

Report: Karoline Laarmann

Since February 2008, the Federal Joint Committee (G-BA) has been trying to exclude short acting insulin analogues completely from reimbursement by the statutory medical insurers. Why? Insulin analogues are 30% more expensive than human insulin.

Credit: sanofi aventis
Credit: sanofi aventis

The G-BA sets guidelines for the list of all the services and products to be covered by the statutory medical insurers (GKV) and therefore decides what services will be reimbursed through the insurers. However, in May 2008, the Federal Ministry of Health (BMG) objected to the decision not to reimburse insulin analogues and instructed that the insurers had to reimburse these insulin preparations for Type 1 diabetics up to the age of 18, despite the higher costs involved.

The Federal Ministry reasoned that with the additional cost of 50 cents daily the savings potential of €2.4 million for the G-BA was comparatively small.
This was a great victory for young diabetics who will particularly benefit from treatment with short acting insulin analogues and the added flexibility this offers for their daily routine. Due to the shortened interval between injecting and eating, activities such as sport and play can be carried out more spontaneously. Additionally, the fast correction of blood sugar levels reduces the development of severe and expensive complications and secondary diseases

Nonetheless, it didn’t take long for a counter attack. Within the same year, the G-BA instructed the independent Institute for Quality and Efficiency in Health Care (IQWIG) to check exactly what benefits the treatment with short acting insulin analogues for Type 1 diabetes has particularly for children and adolescents. The Institute stated that, due to a lack of available data – in particular the lack of long-term studies – no proof for an additional benefit could be found. Therefore, in February 2010, the G-BA concluded that the desired treatment objective could be achieved just as functionally -- but more cost effectively with human insulin. Put simply: In future, more than 50% of the 25,000 children with Type 1 diabetes will have to switch to treatment with human insulin, or their parents will have to pay for insulin analogues themselves.

A step backward, rather than progress, agreed experts countrywide. Professor Thomas Danne, President of the German Diabetes Association (DDG) said: ‘Blindness, kidney failure, premature stroke – these risks had been significantly lowered through improved treatment with short acting insulin analogues. To think that these therapeutic agents might now become unattainable for many children is rather scary.’
In all highly industrialised countries, short acting insulin analogues have been recommended for children, adolescents and those with insulin pumps by the welfare systems, as well as specialist medical and scientific associations, and they are reimbursable.

In May, the DDG and the German Association for Diabetes Education and Counselling Professions (VDBD) therefore petitioned in the German Bundestag (Federal Parliament) for the medical insurers to continue reimbursing the costs of this treatment.

A decision has not yet been reached.


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