How Do I Qualify for CGM Reimbursement in Israel?

Although there is much critique of the drawbacks of “socialized medicine,” the socialized health care system in the State of Israel his on the cutting edge of diabetes technology reimbursement. Virtually any diabetic who needs and/or wants an insulin pump can get one from his/her HMO, as they are included in the basket of services offered to all citizens. Getting a CGM device, however, is a bit more complicated, especially if you are an adult male.

In 2010, the Israeli Ministry of Health took a big step forward, including CGM’s for any diabetic up to the age of 18. The following year, pregnant women – or women trying/planning to get pregnant – also became eligible. In 2012, adult males over the age of 18 suffering from “hypoglycemia unawareness” were added to the mix. Though there were high hopes that the eligibility floodgates would open to all in 2013, in the end no changes were made to the service basket with regards to CGM’s.

So how does the Israeli Ministry of Health define hypoglycemia unawareness? Basically, you need to arrive at a hospital emergency room – or be taken to the hospital in an ambulance – with a blood sugar level below 50 mg/dl. If such an event occurs twice in the course of a 12-month period, then you become automatically eligible for a fully subsidized CGM from your HMO.

Once you have your CGM – currently the Abbott Labs FreeStyle Navigator II and the Medtronic Enlite systems are available, though the models may differ depending on the HMO – the consumables are also covered. Each HMO has its own out-of-pocket ceiling for those with chronic diseases/illnesses; my HMO Maccabi, for example has a monthly ceiling of NIS 256 (~$70) or semi-annual limit of NIS 1,024 (~$280).

The one-time cost of a FreeStyle II from the Israeli Abbott Labs agent Geffen Medical without HMO reimbursement in Israel cost less than $2,000, while the monthly consumables would set you back NIS 2,500 ($670).

Here’s a great overview of the Israeli healthcare system from Michael Aviad, founder of the ASweetLife.org online diabetes journal.