INNOVATION, ACCESS AND AFFORDABILITY: THE ECONOMICS OF DIABETES TECHNOLOGY REIMBURSEMENT IN GREECE, 2012-2025
Author(s)
Maria G. Panousopoulou, BSc, MASc, MBA, MSc, PhD1, GEORGE IOANNIS GIANNAKOPOULOS, MSc2, Eleni Makopoulou, MSc3, ANGELO P. ALOGAKOU, BA, MSc4, PANAGIOTA LITSA, MSc, PharmD5, Theodore G. PAPAIOANNOU, PhD6.
1Director, EOPYY Greece, Marousi, Greece, 2Greek National Health Service Organization, MAROUSI ATHENS, Greece, 3EOPYY Greece, Marousi, Greece, 4EOPYY, ATHENS, Greece, 5Greek Ministry of Health, ATHENS, Greece, 6Medical School, National and Kapodistrian University of Athens, Athens, Greece.
1Director, EOPYY Greece, Marousi, Greece, 2Greek National Health Service Organization, MAROUSI ATHENS, Greece, 3EOPYY Greece, Marousi, Greece, 4EOPYY, ATHENS, Greece, 5Greek Ministry of Health, ATHENS, Greece, 6Medical School, National and Kapodistrian University of Athens, Athens, Greece.
OBJECTIVES: Technological innovation has transformed diabetes management over the last decades through the introduction of insulin pumps, continuous glucose monitoring (CGM) and flash glucose monitoring systems (FGM). In Greece, reimbursement policies evolved through successive revisions of the Unified Health Benefits Regulation (EKPY) of E.O.P.Y.Y., while the implementation of electronic prescribing and closed budgets in 2017 introduced new expenditure control mechanisms. OBJECTIVES: To evaluate the evolution of reimbursement policies for diabetes technologies in Greece between 2012 and 2025, assess the adequacy of closed budgets in supporting access to innovation, and examine the financial sustainability of the reimbursement system.
METHODS: A retrospective health policy and budget impact analysis was conducted. Reimbursement provisions included in the 2012, 2018 and 2025 EKPY regulations were compared. Annual closed-budget allocations, expenditure ceilings and clawback rates for diabetes-related medical devices were analyzed between 2017 and 2025.
RESULTS: The reimbursement framework expanded from conventional self-monitoring supplies to advanced diabetes technologies, including insulin pumps and CGM. Following the introduction of electronic prescribing, annual closed budgets increased from €60.0 million in 2017 to €89.9 million in 2025 (+49.9%). New budget categories were introduced to accommodate emerging technologies, with funding for glucose monitoring systems increasing from €17.7 million in 2022 to €27.0 million in 2025. Despite these increases, substantial clawback obligations persisted across reimbursement categories, reaching 22.6% for diabetes consumables, 25.1% for insulin pump technologies and 21.5% for glucose monitoring systems. Findings suggest that technology uptake and expanding patient access outpaced budget growth, with ethical and social implications for people living with diabetes.
CONCLUSIONS: The Greek reimbursement system substantially improved access to diabetes technologies. Nevertheless, persistent clawback levels indicate that budget growth has not fully matched the expansion of technology coverage and patient demand. Future reforms should incorporate HTA mechanisms and negotiations to ensure equitable access and long-term sustainability.
METHODS: A retrospective health policy and budget impact analysis was conducted. Reimbursement provisions included in the 2012, 2018 and 2025 EKPY regulations were compared. Annual closed-budget allocations, expenditure ceilings and clawback rates for diabetes-related medical devices were analyzed between 2017 and 2025.
RESULTS: The reimbursement framework expanded from conventional self-monitoring supplies to advanced diabetes technologies, including insulin pumps and CGM. Following the introduction of electronic prescribing, annual closed budgets increased from €60.0 million in 2017 to €89.9 million in 2025 (+49.9%). New budget categories were introduced to accommodate emerging technologies, with funding for glucose monitoring systems increasing from €17.7 million in 2022 to €27.0 million in 2025. Despite these increases, substantial clawback obligations persisted across reimbursement categories, reaching 22.6% for diabetes consumables, 25.1% for insulin pump technologies and 21.5% for glucose monitoring systems. Findings suggest that technology uptake and expanding patient access outpaced budget growth, with ethical and social implications for people living with diabetes.
CONCLUSIONS: The Greek reimbursement system substantially improved access to diabetes technologies. Nevertheless, persistent clawback levels indicate that budget growth has not fully matched the expansion of technology coverage and patient demand. Future reforms should incorporate HTA mechanisms and negotiations to ensure equitable access and long-term sustainability.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
MT23
Topic
Health Policy & Regulatory, Health Service Delivery & Process of Care, Medical Technologies
Disease
Diabetes/Endocrine/Metabolic Disorders (including obesity), Personalized & Precision Medicine