To improve the quality of care for patients with diabetes and facilitate informed decision-making by healthcare professionals regarding treatment strategies for the doctors, the National Health Insurance Administration (NHIA) has announced a relaxation of payment restrictions for continuous glucose monitoring (CGM) devices. This policy shift, effective from November, 1, 2023, extends coverage to encompass pregnant patients with type 2 diabetes or patients with gestational diabetes undergoing insulin injection treatments. In addition, the NHIA has updated regulations of CGM device payments for patients with type 1 diabetes. The National Health Insurance (NHI) now covers for patients to adopt treatments with CGM devices on a one-month interval instead of the three-months interval. This modification ensures real-time monitoring of glucose and treatment progress. The implementation of these two adjustments is projected to benefit an additional 512 individuals annually, with an approximately NT$2.5 million investment from the NHI.
The NHIA specified that diabetes ranks as the third-highest contributor to total NHI healthcare costs, exceeding 40 billion points annually. Patients with diabetes need to take fingerstick tests frequently to provide references for their treatment plans. However, the results of such tests are susceptible to various factors, including patients' routines, insulin dosages, and the timing of the test. Since 2017, the NHIA has included the CGM devices in the NHI payment package for patients with type 1 diabetes, neonatal diabetes, and patients with diabetes following a pancreatectomy. By implanting a glucose sensor under the skin, the CGM devices can conduct a continuous long-term recording of glucose fluctuation over 3 to 5 days. The recorded data provides doctors a more comprehensive understanding of the impact of patients' diets, exercise habits, sleep patterns, daily routines, and medication adherence on their glucose levels. Consequently, precise medication prescription can be tailored to individual needs. The CGM procedure is performed approximately 1,692 times each year.
In addition, pregnant patients with diabetes whether pre-existing or gestational diabetes, may lead to hypertension, preeclampsia, ketoacidosis, and a higher risk of congenital disorders for the fetus. To ensure glucose stability during pregnancy, NHIA has incorporated high-risk groups, namely, pregnant patients with type 2 diabetes and patients with gestational diabetes, into the CGM devices payment package. Continuous glucose monitoring is expected to minimize the risk of the onset of complications, ensuring the safety and health of both the parent and the child.
The NHIA shall continue to optimize the integrated care for chronic diseases and aim to slow down the diseases' progression and prevent complications. Moreover, the precision of clinical diagnosis and treatments is expected to improve with reasonable allocations of NHI resources. The goal of the NHIA is to safeguard the health of all the insured and ensure relevant regulations are in line with global trends.