FreeStyle Libre CGM Sees Rising Use With Pharmacy Chain Distribution

When the FDA approved Abbott’s FreeStyle Libre Flash continuous glucose monitoring (CGM) system in September 2017, diabetes advocates hailed the move as long overdue and one that might lead to greater penetration of glucose monitoring technology for those with type 2 diabetes (T2D).¹

The Flash CGM, which is also available in a Pro model for use by physicians,² was the first product that allowed people with diabetes to see how what they ate and drank or how exercise affected their blood glucose levels without the need for a daily fingerstick test to calibrate the device. Users wear a sensor on their upper arm and wave a reader over it to record blood glucose data (see Figure).

Although some patients with type 1 diabetes favor sensors and alarms on competing products, pricing and cost-sharing decisions by payers have sometimes put traditional CGM systems out of reach. For patients with T2D, payer coverage has been even harder to come by; when Medicare added CGM coverage, it was limited to those performing at least 4 finger-stick tests per day.³

The Abbott CGM system includes a 1-time cost of $69 for the reader and $120 for a pair of 14-day sensors; those with insurance pay between $40 and $75 a month.4 Aaron Neinstein, MD, director of clinical informatics at the University of California at San Francisco Center for Digital Health Innovation (see Cover Story), wrote earlier this year that Abbott’s price point was more affordable than most CGM systems but could be still out of reach for many with diabetes.⁵

Based on information shared with investors, it appears payers and people with diabetes are responding to both the price point and a decision to distribute the product through the pharmacy chain.^6,7 During the company’s January 23, 2019, earnings call, Abbott reported that global sales of the FreeStyle Libre increased $1 billion in 2018, up 100% from the prior year; the company reported 300,000 new users in the fourth quarter of 2018 alone, bringing worldwide users to 1.3 million.⁶

The pharmacy chain has proved increasingly popular for diabetes products. After struggling for years with barriers to receiving coverage for its popular Omnipod insulin pump as durable medical equipment under Medicare Part B, Insulet gained coverage through the pharmacy chain under Medicare Part D last year.⁸

The FreeStyle Libre Flash CGM is approved for users 18 years and older in the United States.¹ In October 2018, the FDA approved the FreeStyle LibreLink, an app that works with iPhone 7 and later, running iOS 11 and later.⁹

Evidence-Based Diabetes Management™ (EBDM) asked Abbott officials about progress with pharmacy chain distribution and how payers have responded:

EBDM: Can you discuss the thinking that led to pharmacy chain distribution? What were the pros and cons? ABBOTT: At Abbott, we believe that access to information about your health should be painless, easy, and convenient. Many patients with diabetes use the pharmacy as a primary source for obtaining testing supplies today, and we wanted to enable patients to be able to continue to access their CGM supplies in the channel they find most convenient. In addition, eRx [e-prescription] prescribing systems are broadly used by physicians today, so prescribing the FreeStyle Libre system in pharmacy can be seamless, which has enabled broad uptake of [the] FreeStyle Libre system without the hassle of paperwork.

We also have distribution through the durable medical equipment [DME] channel, as [the] FreeStyle Libre system is covered under the medical benefit. This channel has seen particularly strong uptake for government insured patients, such as [those covered by] Medicare.

Overall, our goal at Abbott is to be able to have broad availability for FreeStyle Libre patients whether it is in pharmacy or through the DME channel.

EBDM: How is pharmacy chain distribution going at this point? What do CGM users like about this method? What unexpected issues still need to be corrected? ABBOTT: So far our pharmacy distribution has been successful. [The] FreeStyle Libre system is available in all pharmacy channels, and from our data, we are the primary providers of CGMs to this distribution channel. Abbott is investing a significant amount of resources in education of pharmacists since CGMs is a new category to pharmacies. It is critical for pharmacists to be knowledgeable about this technology to provide the right guidance to patients. We see this as an ongoing need as we continue to increase adoption of our FreeStyle Libre 14-day system. In addition, patients like the convenience of being able to pick up their CGM supplies along with their other prescriptions.

EBDM: Are payers receptive to this method of distribution? Do you see use of the pharmacy chain expanding as use of technology and digital health tools increase? Do payers have the right personnel on their end to work with you on these transactions? ABBOTT: We have found that payers are very receptive to managing CGM through the pharmacy channel. Use of the pharmacy channel offers significant cost savings, the ability to easily track utilization and to offer their members a simple and convenient place to get their product. We have extensive experience working with payers, based on our blood glucose monitoring business, and we’ve been able to leverage this knowledge and experience to continue to secure access for CGMs.

REFERENCES:

1. Caffrey M. FDA approves Abbott continuous glucose monitor that doesn’t need routine finger sticks. The American Journal of Managed Care^® website. ajmc.com/newsroom/fda-approves-abbott-continuous-glucose-monitor-that-doesnt-need-routine-finger-sticks. Published September 28, 2017. Accessed February 25, 2019.
2. FreeStyle Libre Pro indications and safety information. abbott. com/corpnewsroom/products-safety-info-pages/diabetes-freestyle-librepro.html. Accessed February 25, 2019.
3. Caffrey M. Medicare issues rules for CGM coverage—no smartphones allowed. The American Journal of Managed Care^® website. ajmc.com/newsroom/medicare-issues-rules-for-cgm-coverage-no-smartphones-allowed. Published March 28, 2017. Accessed February 25, 2019.
4. Kwon J, Levine B, Brown A. FreeStyle Libre in US now approved for 14-day wear and 1-hour warmup. diaTribe website. diatribe. org/freestyle-libre-us-now-approved-14-day-wear-and-1-hour-warmup. Published August 7, 2018. Accessed February 25, 2019.
5. Neinstein A. By 2025, a lot more people will be tracking their blood sugar, predicts doctor—here’s why. Health Tech Matters. CNBC website. cnbc.com/2019/01/31/blood-sugar-tracking-useful-for-more-than-diabetes-commentary.html. Published February 1, 2019. Accessed February 25, 2019.
6. Abbott news and events. Q4 2018 Earnings conference call. Abbott website. www.abbottinvestor.com/news-and-events. Published January 23, 2019. Accessed February 25, 2019.
7. Caffrey M. Abbott’s FreeStyle Libre CGM gains Medicare coverage. The American Journal of Managed Care^® website. ajmc. com/newsroom/abbotts-freestyle-libre-cgm-gains-medicare-coverage. Published January 5, 2018. Accessed February 25, 2019.
8. Caffrey M. After long wait, Omnipod achieves coverage through Medicare Part D. ajmc.com/newsroom/after-long-wait-omnipod-achieves-coverage-through-medicare-part-d. Published January 12, 2018. Accessed February 25, 2019.
9. FreeStyle LibreLink app FDA approved. Abbott website. abbott. com/corpnewsroom/product-and-innovation/freestyle-librelink. html. Published November 1, 2018. Accessed February 25, 2019.

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