Reimbursement of Continuous Subcutaneous Insulin Infusion (CSII) Pump Therapy: ECHS Guidelines

 

No 22D(22)/2024/WE/D (Res-1)
Government of India
Ministry of Defence
D/o Ex-Servicemen Welfare
D(WE/Res-I)

237, B- wing
Sena Bhawan, New Delhi
Dated: 2nd April, 2025

To

The Chief of Defence Staff
The Chief of Army Staff
The Chief of Naval Staff
The Chief of Air Staff

GUIDELINES REGARDING REIMBURSEMENT OF CONTINUOUS SUBCUTANEOUS INSULIN INFUSION (CSII) PUMP THERAPY

Sir,

1. Please refer Min of Health & Family Welfare, EHS Section O.M. No. S.11030/120/2022-EHS dated 16 May 2023 (copy att).

2. As per the existing provisions Insulin pump etc which are issued to ECHS beneficiaries for which no ECHS ceiling rates exist and are recommended for domiciliary use for ECHS beneficiaries by Service Specialist/Govt Hospital Specialist will require prior sanction of the High Power Committee. ECHS has framed following guidelines for use/reimbursement of cost of Insulin Pump as laid down in the letter under ref at Para 1:-

(a) Eligible Patients. The fwg criteria must be met :-

(i) Patients with Type – I Diabetes

(ii) Duration of diabetes greater than 2 years

(iii) The child and family have received adequate diabetes education at a centre experienced in  taking care children with Type-I, Diabetes Mellitus.

(iv) Despite multiple daily dose of Insulin proper adherence to diet in last 6 months, HbA1C level is not below 8.50%.

(v) Recurrent and unexplained hypoglycemia on multiple doses of insulin despite proper adherence to diet in last 6 months.

(b) Prerequisites. Should be on multiple daily doses of Insulin (basal bonus) therapy for a minimum of 6 months. During the period there should be.

(i) At least 2 HBA1C readings over these 6 months.

(ii) Strict Self-Monitoring Blood Glucose (SMBG) with minimum 4 readings or be on Continuous Glucose Monitoring System (CGS).

(iii) Should have a concept of carbo-counting (Counting number of grams of Carbohydrate in a meal) and its application in diabetes management, as certified by the treating pediatric endocrinologist / endocrinologist / diabetes clinic specialist.

(iv) The family can understand pump usage, to calculate bolus and nasal insulin doses as required, and has demonstrated motivation to follow guidelines related to SMBG monitoring and diet.

(v) Regular follow-up with a pediatric endocrinologist/ endocrinologist / diabetes clinic specialist.

(vi) No history of psychiatric illness in patient.

(c) Approval. As per CO ECHS letter No B/49761/AG/ECHS/Medicine Policy/2023 dated 30 Nov 2023.

(d) Validity.

(i) Initial approval shall be for one year. Both basic as well as sensor augmented Insulin Pumps may be considered as prescribed by treating endocrinologist.

(ii) Re-Approval will be done only if the following criteria are met:-

(aa) regular follow-up (at 3 months intervals at least) during the past one year.

(ab) Regular self monitoring of blood glucose (SMBG)

(ac) HbA1c test every 3 months over past one year with at least two HbA1c values below 8.5%.

(iii) If re-approval is not granted as above, the patients can re-apply after 6 months, if he/she meets these criteria – HbA1c less than 8.5% at least one in last 6 months.

(e) Ceiling rate for Continuous Subcutaneous Insulin Infusion (CSII) Pump Therapy.

(i) Ceiling rte for basic version of Insulin Pump are fixed at 2 lakhs.

(ii) Ceiling rate for a sensor-augmented Insulin Pump are fixed at Rs 3 lakhs.

(iii) In addition, the monthly cost for the consumables is fixed at Rs 5,000/- (reservoir, infusion set and Insulin).

9. The instructions will be implemented from the date of issue of this letter.

10. It is also advised that the Committee should be headed by a Medical Doctor with a Specialist member as proposed under:-

i.                OSD as Medical Head

ii.                Doctor of R&R as Specialist

iii.                Rep of CO, ECHS

11. This has the concurrence of MoD (Fin) vide their ID Note No. 33(22)/2024/Fin/Pen dated 05.03.2025.

Yours faithfully,

(Dr. P.P. Sharma)
OSD, D(WE/ I&C)