Diabetes is a Chronic Disease listed under the Social Security Act and affected patients are entitled to free medicines as listed on the Government Formulary. However, in contrast to other chronic diseases, in the past, diabetic patients were also given the option to have both the Yellow (Schedule V) card or the Pink (Schedule2) card even if not means tested….

 

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DH Circular 8/2017

DH 3036/2016

30th January 2017

To All Health Care workers

 

Switchover of Schedule II to Schedule V card in case of Diabetic patients

 

Diabetes is a Chronic Disease listed under the Social Security Act and affected patients are entitled to free medicines as listed on the Government Formulary. However, in contrast to other chronic diseases, in the past, diabetic patients were also given the option to have both the Yellow (Schedule V) card or the Pink (Schedule2) card even if not means tested.

 

In 2012, an initiative was undertaken to address this anomaly and entice diabetic patients to relinquish the Pink Card (when NOT means tested) in favour of the Yellow Card in line with the Social Security Act. Patients with yellow card for diabetes have been entitled to better entitlements as regards diabetes, which includes entitlement to new diabetic treatments. Since 2012 newly diagnosed patients were only issued with Yellow Schedule V cards.

Following the publication of the National Diabetic Strategy in 2015, new diabetes initiatives have been and are still being launched.

 

In 2016, Repaglanide and Gliptins were introduced for the first time on the Government Formulary and the entitlement of up to 120 Blood sugar monitoring strips for Type 1 diabetics was increased from a maximum of 18 years of age to include all ages.

In January 2017, an initiative was launched to further address the anomaly mentioned above.

 

The following corrective actions have been launched and as a result diabetic patients with a valid Yellow Schedule V card will NOW also be entitled to:

 

  • New medicines introduced for the management of diabetes. These include Repaglanide and Gliptins (introduced in 2016), as well as, the new analogue insulin to be introduced later in 2017 for patients who are uncontrolled, whether they are Type 1 or Type 2.
  • Blood sugar monitoring sticks
    • Since last year (2016) the entitlement of up to 120/month blood sugar monitoring strips for Type 1 diabetics was increased from a capping of 18 years of age to include all ages.
    • Later in 2017, Insulin-requiring Type 2 diabetic patients who have a Schedule V card will also be given blood sugar monitoring strips so that they can better monitor and control their glycaemic profile at home.
  • Subsidy onspectacles – To encourage better ophthalmic care in diabetics, the subsidy on spectacles will now be extended to diabetic patients with a valid Schedule V (yellow) card Prescription has to be made on forms issued specifically by the Department of Health. The date when this measure will becpome effective will be announced later
  • Free dental treatment which includes dental check up, fillings and dentures carried out at Mater Dei Hospital
  • Antibiotics – up to three courses per year according to set protocols which would require prescriptions from doctors in the community both public and private or consultants, the latter required in case of chronic diabetic related wound infections. List of antibiotics listed in Annex 1 below.
  • Insulin syringes: 
    • currently irrespective if they use more or less, diabetic patients with
      • Schedule II (pink) card are entitled to 10 syringes per month
      • Schedule V (yellow) card are entitled to 30 syringes a month . 
    • Now patients with a Schedule V (yellow) card will be entitled to 60 syringes per month.
  • Rebates on Telecare services like holders of Schedule II
  • Aqueous cream

 

Diabetic patients with a valid Pink (Schedule 11) card can opt to retain and renew this card.   and will retain same rights they currently have. They will still be entitled to medicines prescribed for acute non chronic conditions, listed in Annex 2 below but will not benefit from the new measures being introduced for yellow (Schedule V) card holders

 

As a matter of procedure, diabetic patients who opt to switch over to the Yellow Schedule V card to benefit from the new initiatives are to present to the regional office of the Department of Social Security (DSS) when their current pink card expires to sign their intent. A valid SLH 145 form is to be presented. The DSS officer will scan the signed document to the Pharmacy of Your Choice diabetesstrategy.poyc@gov.mt. A new Schedule V card will then be sent by post to the patient. This will avoid patients having to run from one office to another. 

 

To facilitate matters, if the SLH 145 form has expired, this may now be renewed by the Diabetic Specialists either in the local Health Centres or at Mater Dei Hospital.

 

Patients who are diabetic who never had a Schedule V (yellow) card or have never utilised the public services and would like to start doing so, will have to be referred to the Diabetic Clinic at MDH as new cases for an initial visit and in order to apply for a Schedule V card.

 

It is important to note that diabetic patients with Pink Card (Schedule II) because they are means tested will not be affected by the changes being proposed. In order to benefit from the new treatment and initiatives they will still need to apply for a Schedule V card but will NOT lose their pink card.

 

New DH Circulars will be issued to inform all when the new initiatives planned for 2017 will be launched

Annex 2 below attempts to summarise the difference in entitlement for diabetic patients with Schedule V (yellow) and Schedule  II (pink) card, before and after the launch of this initiative.

 

In case of doubts, customer care officials with in our Ministry will be available to clarify matters

 

Dr. Denis Vella Baldacchino

Chief Medical Officer

 

 

 

Annex I

 

  1. Antibiotics – As of 1st January 2017 ALL diabetic patients, regardless of whether they are  Type 1 or Type 2 diabetics, with a valid Yellow Schedule V card for diabetes or Schedule II card are entitled to the following antibiotics that will be classified into two groups: Those that can be prescribed by doctors in the community (public or private), which prescriptions cannot exceed ten (10) days duration and the number of episodes should not exceed three per calendar year. If longer courses are believed to be required, advice from respective caring physician should be sought. The antibiotics include:
    1. Amoxicillin capsules 250mg, Syrup 125mg/5ml
    2. Cefalexin capsules 250mg, Syrup 125mg/5ml
    3. Doxycycline capsules 100mg
    4. Erythromycin capsules/tablets 250mg, syrup 125mg/5ml
    5. Flucloxacillin capsules 250mg, syrup 125mg/5ml
    6. Metronidazole tablets 200mg, suspension 200mg/5ml
    7. Nitrofurantoin tablets 50mg, syrup 25mg/5ml
    8. Amoxicillin + Clavulanic Acid Tablets 250mg + 125mg

 

  1. Antibiotics that can be prescribed by Consultants for chronic wound infections related to diabetes. These include all of the above, as well as:
    1. Ciprofloxacin capsules 250mg
    2. Clindamycin capsules 150mg
    3. Co-trimoxazole 400mg + 80mg
    4. Fusidic Acid

 

These antibiotics will be available only from the pharmacies at Floriana and Paola Health Centres, as well as, the pharmacy at Gozo General Hospital and after office hours from the in-patient pharmacy at Mater Dei Hospital.

 

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