Anybody hear anything about UHC making Medtronic the “preferred” insulin pump? I saw something from diabetes mine. Hope it’s not true.
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Check out Page 7 and unfortunately I think that it is true.
And on Page 4, it looks as though they are going to think that A1c’s below 9 are good enough for Medicare recipients.
Tandem is taking th threat seriously: Tandem Diabetes Care Announces Upcoming Change to UnitedHealthcare Customer Access | Business Wire
I live near UHC’s headquarters. Shall I go egg them?
This is some real BS. I have UHC but I believe my pharmacy benefits which cover the pumps I hope. I called about the omnipod and the pods are covered by my pharmacy but the receiver I would have to pay out of pocket. What is happening is big companies linings each other pockets.
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Open letter to HR Departments and recruiters: If your health insurer is UHC, don’t even bother to contact me.
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Problem is – I already work for a company that uses UHC… Boss will be in town tomorrow – I plan on mentioning it to him - though he’ll more likely find a solution for ME without necessarily changing things for the group. We’ll see…
What the heck. I have UHC through the Healthcare exchange and it’s a very good plan. I’d hate to have to change AGAIN because of this. Luckily my t:slim is still in warranty for 2 more years. Hopefully they will have come to their senses before then. At least I have the option to change.
“Having diabetes isn’t a choice. How people manage it should be,” said Kim Blickenstaff, president and CEO of Tandem Diabetes Care. (great quote from the business wire article @Laddie linked to above. Btw, I wouldn’t object to the egging idea).
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I don’t know if this article is accurate, but it says omnipod is exempt from this:
If anyone is motivated, they should try to loop in the mainstream media on this one. People on specialty diabetes blogs and websites are unlikely to make UHC take notice. But in my experience, just having a local newspaper report on someone needing medical care but not getting it can often get insurance companies to change their policies.
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This is the blogpost I published today regarding the UnitedHealthcare mandate for Medtronic products.
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Competition Restrained?
By:Rick Phillips | May 6, 2016 | General, News, Type 1 Diabetes, Type 2 Diabetes | No Comments
Most of us in the diabetes community are very upset about the recently published United Health Care (UHC) deal with Medtronic. To review, as best as I understand, Medtronic and UHC have announced an agreement that will limit the purchase of pumps after July 1 for people covered by UHC plans exclusively to Medtronic. Diabetes Mine, Diatribe, and Dpac provide a full explanation which I hope you will read. Their reporting is outstanding so I will not restate it here. I will, however, make one note; this will not apply to individuals covered by Medicare supplemental plans at this time. As of my last reading, the Diabetes Mine article excluded that fact.
- See more at: Competition Restrained? - RADiabetes
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Thank you for this post. I had no idea the Animas Vibe was completely waterproof! For some reason, when I was looking at insulin pumps a year or two ago, I’d gotten the impression that the Omnipod was kind of the only game in town if you spent a lot of time in water and didn’t want to unhook.
I actually have somewhat mixed feelings about this. Insurance companies define preferred drugs and medical devices all the time. We even have this happen with insulin. And it is common to have preferred glucose meters. Why are insulin pumps different? What makes them special? I’m not saying that the practice isn’t objectionable, I just think there needs to be clarity about why pumps are different.
Valid points Brian-- and why shouldn’t equal onus be placed on each pump company to negotiate acceptable rates with each insurer? There are two sides to each negotiation…
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With medications, the differences between medications are sometimes (but not always) minimal. In the case of insulin pumps though the differences can be huge.
As I pointed out elsewhere, a big difference between say, the Animas Vibe that I’ve recently only learned of and the Medtronics pumps is that the Vibe is waterproof. For someone like myself whose ONLY real form of exercise is in the water, that’s a very, very huge deal. The Vibe also has a max bolus of 35U where the Medtronic only has a max bolus of 25. The Vibe boluses 5U in 8.3s where a Medtronic or Omnipod take 183s to bolus 5U. If I’m understanding that right, that means it would take 5x183s = 915s = 15.25m to bolus 25U of insulin from a Medtronic, and then I’d still have to go back and bolus an additional 10U if, for some reason, I needed to bolus 35U of insulin. The Vibe would manage that bolus in 58.1s, or under a minute.
Wouldn’t these kinds of things mean MASSIVE differences in blood glucose control for a very insulin-resistant T2 who spent a lot of time in water?
I get that some insulins work better than others for some people. But in the case of say, a waterproof vs. a non-waterproof insulin pump, you’re pretty much talking the difference between working and not working AT ALL for at least some periods of time out of the day.
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@Brian_BSC, these are good questions. On another DOC blog, I had someone ask if MY preferred pump was 3 times the cost of UHC’s Medtronic pump, should UHC be obligated to cover the one I want? (Also a good question).
I think there are multiple facets and nuances here.
The first is that insurers (aka the Payers), have increasingly put themselves right in the middle of the patient-doctor relationship. I sometimes wonder if appointments might go more smoothly if we had an insurance presence directly at the appointment? Is this appropriate for them to be so deeply embedded in this formerly sacrosanct relationship? Overall, I think not.
Next is the fact that with strips, meters and insulin brand preferences the insurance companies (and PBMs) have presented these type decisions on more of an individual basis, so even though many of us have been forced to make a change, there hasn’t been the blanket press announcement like the one made by UHC/MDT regarding pumps. So in many respects, I think this type of brand preference has been sneaking up on us, or if you prefer, we’ve been a bit like frogs in a pot of warm water on its way to boiling.
Another piece is that pumps often represent a big upfront expense. In my case, where I struggle to afford the technology pieces under the current policies, I am perhaps extra sensitive to being told that if I don’t choose the Medtronic 530G, I will have to pay a non-network premium. This is especially true when I have closely looked at the Medtronic pump and realized that I would have to make significant compromises to the way I live my life. I work hard to be a person who just happens to have diabetes, not a diabetic who just happens to be a person. This decision makes the latter more likely for me. In short, pumps are both fundamentally the same, while being very different in the way we interact with them.
I recently went through a mandated change to Novolog from Humalog that I wasn’t too happy about. Ultimately, that one turned out ok for me, because I can use those two insulins without any basal/bolus changes. But, that sadly isn’t the case for everyone and those who can’t make the change a faced with fighting with their insurer. More on this in a bit.
Yet another thing to consider is on the device manufacturers. Like SLR camera manufacturers (Canon, Nikon, Minolta, Konica, etc) with proprietary lens mount systems, our pump/meter companies are too locked into their proprietary systems, making it difficult for us to use the best devices interchangeably, and allowing us to have access to our own data.
So for me, the UHC/Medtronic announcement is a bit like the straw that broke the camel’s back. All of these issues are important. We need to have access to the right equipment and the right therapies/diagnostics, etc. We should be able to have an unhindered discussion with our healthcare team. We should be able to deviate from the “preferred” whatever without resorting to lengthy and convoluted appeals processes that treat us as second class citizens and processes that favor the initial decision of denial.
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This development troubles, but as many have pointed out, it is merely an extension of previous policies that we already accept. We patients have a critical stake in these kinds of decisions yet have no direct seat at the decision making table. The ADA and JDRF can and do exert influence but they can be over-powered by the payers and manufacturers.
This reminds me of the clever adage, “If you’re not at the table, then you’re probably on the menu.” The payers and manufacturers talk a good game about “patient-centered care,” but when their bottom line competes with our interests, we all see which direction things go.
There are few counter-balances that we as patients can use to gain real world power in these cases. We can embarrass the payers and manufacturers in the press. This may be the the best and most accessible tool we have. We can choose to boycott the manufacturers products but boycotts often don’t reach critical mass. And who would want to compromise their health in the process? We could lobby our government representatives to enact legislation on our behalf, but, unfortunately, our democratic process has been undermined by the same big money that put forth the policy in question.
Patients deserve equal real-world power when these decisions are made. It is a public good that benefits society as a whole even though it may trim the often-exorbitant profits of these players. I mostly fault the payers in this equation. But the manufacturers are partially responsible for bending market forces against the very competitive nature of the market to which they pay lip-service.
I don’t have an answer to this problem. We have few options and if we’ll ever be serious about this then we need to express our stories in the press in hopes of embarrassing companies like UHC and Medtronic or we need to wrest control of our political process from the big-money players. Unfortunately we, as an electorate, are divided to the benefit of the the other market forces. Our highly partisan democratic process effectively neutralizes whatever power we might naturally claim.
This is a tough nut to crack.
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There’s also this from Gary Scheiner:
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@YogaO – That’s a worthwhile article by Gary Scheiner. Insulin pumps are definitely not a commodity. Another critical feature of any insulin pump is its user interface. The software that interacts with the human operator does influence how well the user exploits the strengths and minimizes the weaknesses of the particular device.
We are not all wired in the same way and some user interfaces feel more natural to us and the logic of their interface can often let us intuitively guess about how to use a pump function that’s a new or uncommon to us. Due to the nature of diabetes with attendant hypo- and hyper-glycemia, we need a strong user interface that plays to our individual nature and preference so that it increases the chances of making and executing the right pump action at the right time. Even with our BG-impaired brains, we make dozens of critical pump decisions each day, some with the potential of serious detrimental health consequences.
Diabetes plays for keeps; we need tools best suited to our individual needs. What we don’t need is a single tool chosen by an entity hard-wired for profit and blind to living with a metabolic disorder in the real world.
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I guess we can’t do much with regard to UHC. But imagine if we all boycotted medtronic!
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