What is Fiasp?
Fiasp, a fast-acting aspart insulin has been a valuable treatment option for people with diabetes in Australia since it was listed on the Pharmaceutical Benefits Scheme (PBS) in 2018. However, in recent months, there have been concerns that Fiasp may be removed from the PBS, potentially leaving thousands of people with diabetes without access to this important medication. This decision raises crucial public policy issues pertaining to healthcare access, affordability, and transparency in the context of diabetes management. This blog post will delve into these issues and explore the ongoing advocacy (primarily from the diabetes community) to prevent the removal of Fiasp from the PBS.
The PBS; a cornerstone of Australia’s public policy, has provided affordable access to essential medications for eligible residents, including myself. As I was planning my second pregnancy and trying to balance my Type 1 Diabetes around a toddler, I found that the short-acting insulin I had used for over a decade, Novorapid, was not working as well as it previously had for me. I desperately needed an insulin that was much quicker to act and adjust to my blood glucose, as well as allow me more flexibility around pre-meal insulin delivery times. So, once Fiasp became listed on the PBS in 2019, it then allowed me to access affordable, fast-acting insulin that was compatible with my insulin pump and planning a pregnancy with diabetes. In fact, a randomized controlled trial conducted in 2020 in Denmark, compared Fiasp and Novorapid in pregnant women with pre-existing diabetes, and is in the final stages of collating their findings for future publication (Nørgaard et al., 2021)
However, in early February, 2023 there were whispers of the removal of Fiasp from the PBS in the diabetes online communities (Bionic Wookiee, 2023). There was also growing concern of no official announcements being made within official diabetes organisation social media channels, as well as no information coming from pharmacies when community members enquired based on the “rumours” circulating online. It was then finally confirmed through the Department of Health; that the Australian government proposed the removal of Fiasp from the PBS, citing cost-effectiveness concerns (Pharmaceutical Benefits Scheme, 2023). There was a collective uproar from the community immediately following the formal announcement – the removal of Fiasp from the PBS (with a price hike from $7 a month to $280 a month) would create a huge accessibility barrier for the majority of its users, where many would have to return to other insulins that were not as effective, and in turn diminishing their quality of life (ABC News, 2023).
The threat of Fiasp being removed from the PBS has strong implication on accessibility for adequate healthcare for people with diabetes. The cost burden associated with diabetes management in relation to medications and medical appointments is already a pressing concern for the diabetes community (Diabetes Australia, 2022). The removal of Fiasp from the PBS would exacerbate financial challenges, hindering affordability and compromising the overall well-being of people with diabetes. The lack of consultation with the diabetes community, healthcare professionals, and stakeholders surrounding the decision to remove Fiasp from the PBS is also a matter of concern. Transparency and accountability are vital pillars of effective public policy, ensuring that decisions are made with a comprehensive understanding of their impact on those affected (Australian Government Department of Health, 2022).
The diabetes community waited for word from key organisations to see how they would advocate to reverse this decision. Week passed, with not even an acknowledgement social media post or comment on what was deemed by the community as the “Fiaspco” (Facebook, 2023). So the community decided that they were not waiting – a community-led petition was created, and quickly grew to having over 20,000 signatures within days of its establishment (Change.org, 2023). The community-led petition became a campaign with a multi-faceted approach; it utilized social media, petition letters to members of parliament, collaboration with major news organisations and direct engagement with policymakers to raise awareness and generate support (Reddit, 2023).
Whilst the diabetes initiated this campaign, it took over a week from when the PBS news was confirmed for key diabetes organisations to provide an official statement. They did, however, encourage individuals to access the petition and contact their local members of parliament with their concerns (Diabetes Australia, 2023).
Within weeks, the Minister for Health and Aged Care announced that subsidized access to Fiasp via the PHS will be extended for another 6 months, provided that individuals have an existing (and current) prescription to the medication (Diabetes Australia, 2023). Whilst this news was received with thanks from people with diabetes, there were concerns on the lack of clarity around the requirement to have a current script – resulting in miscommunication and distress from the communities involved. The community was still greatly concerned with the lack of stakeholder consultation in the decision-making process for Fiasp being removed from the PBS. In fact, the community still is advocating tirelessly towards continued access to the medication via the PBS, including detailed instructions on completing a submission to the Pharmaceutical Benefits Advisory Committee (PBAC, held in June, 2023) (Bionic Wookiee, 2023). It should be noted that the PBAC in question was not only mentioned in a limited capacity by leading diabetes organisations, but had incorrect instructions on completing the submission, resulting in confusion and misinformation in the greater diabetes community.
Overall, what have I learned as a person with diabetes during the #fiaspco? That the advocacy demonstrated by the diabetes community is strong; it demonstrates the significance of stakeholder engagement in shaping healthcare policy, as well as the collective determination to protect access to life-changing medications. However, the most important aspect in the context of public policy is that the diabetes community want greater transparency and accountability from decision-makers and key organisations associated with the sharing of health information, and that collaboration with people with diabetes before changing policy and delivering official communications is absolutely essential.
ABC Sunshine Coast, Ultra-fast insulin drug Fiasp to be removed from PBS making it unaffordable for many diabetes sufferers, 02 March 2023. Retrieved from https://www.abc.net.au/news/2023-03-02/ultra-fast-insulin-fiasp-diabetes-drug-removed-from-pbs/102043628
Bionic Wookiee David Burren, Catastrophic Insulin decisions in Australia, 25 February 2023. Retrieved from https://bionicwookiee.com/2023/02/25/catastrophic-insulin-decisions-in-australia/
Bionic Wookiee David Burren, Fiasp again – time to act 16 May 2023. Retrieved from https://bionicwookiee.com/2023/05/16/fiasp-again-time-to-act/
Change.org, Belinda Moore, Save Fiasp insulin from falling off PBS…FOREVER…not just 6 months ! 24 February 2023. Retrieved from https://www.change.org/p/save-fiasp-insulin-from-falling-off-the-pbs
Diabetes Australia. A statement from Diabetes Australia about the withdrawal of Fiasp from the PBS, 01 March 2023. Retrieved from https://www.diabetesaustralia.com.au/news/fiasp-withdrawal-from-pbs/
Diabetes Australia. Health Minister Butler’s intervention on Fiasp welcomed by Diabetes Australia, 17 March 2023. Retrieved from https://www.diabetesaustralia.com.au/news/health-minister-butlers-intervention-on-fiasp-welcomed-by-diabetes-australia/
Diabetes Australia. New report reveals dramatic jump in diabetes costs, 14 November 2022. Retrieved from https://www.diabetesaustralia.com.au/mediarelease/dramatic-jump-in-diabetes-costs/
#fiaspo – Explore I Facebook, 03 June 2023. Retrieved from https://www.facebook.com/hashtag/fiaspco
Nørgaard, S. K., Mathiesen, E. R., Nørgaard, K., Clausen, T. D., Damm, P., & Ringholm, L. (2021). CopenFast trial: Faster-acting insulin Fiasp versus insulin NovoRapid in the treatment of women with type 1 or type 2 diabetes during pregnancy and lactation – a randomised controlled trial. BMJ open, 11(4), e045650. https://doi.org/10.1136/bmjopen-2020-045650
Pharmaceutical Benefits Scheme (PBS) I New,amended and deleted. Retrieved from https://www.pbs.gov.au/browse/changes
Reddit. FIASP removed from Australian PBS Scheme, 02 March 2023. Retrieved from https://www.reddit.com/r/diabetes_t1/comments/11fvlqd/fiasp_removed_from_australian_pbs_scheme/