Unitedhealthcare decision — a step backwards for pump access (AGAIN)


#1

Originally published on Beyond Type 1

UnitedHealthcare (UHC) announced in a Network Bulletin last Friday that the Medtronic MiniMed™ 670G will be the preferred insulin pump for patients age 7 and up, following pediatric approval of the 670G last year. The move comes nearly three years after UHC first announced Medtronic as its preferred provider of pumps for adult patients in May 2016. In their recent announcement UHC cited “the safety, quality and lower cost [670G] offers.”

Beyond Type 1 and JDRF have both denounced this decision, and will be working together to fight for patient choice. As was the case in 2016, there is serious concern over UnitedHealthcare — the largest healthcare insurer in the United States — giving preferential coverage to one insulin pump manufacturer.

This morning, JDRF released a statement expounding their position. JDRF Chief Mission Officer Aaron Kowalski told Beyond Type 1 “Every person with Type 1 diabetes, no matter their age, should have the freedom to decide which insulin pump is right for them. It is a choice that should be made by them and their doctors — not an insurance company… Just like diabetes isn’t one-size-fits-all, neither are pumps. Insulin pumps are sophisticated medical devices that save and improve lives, and different ones work best for different people. UnitedHealthcare must reconsider this decision.”

The announcement should not affect Ominpod users or patients who are already getting pump supplies through UHC, at least in the short term. In their announcement UHC stated, “There is no change to coverage for members currently on an insulin pump and receiving supplies. Similarly, there is no change for the use of non-durable insulin pumps such as tubeless pumps.” Omnipod received in-network coverage status from UHC last April.

UnitedHealthcare’s decision to continue to favor Medtronic pumps will have reverberating effects throughout the T1D community. Innovation in the insulin pump market is driven by competition, and preferential treatment of one insulin pump by an insurance company limits patient choice and stifles growth. Since UHC first announced Medtronic as their preferred pump provider in 2016, both Roche and Animas discontinued pump options in the U.S.

Kowalski also added, “Any agreement that limits choice for people with Type 1 diabetes is a step in the wrong direction. Coverage, affordability, and choice of therapies are key components to improve the lives of people with Type 1 diabetes today, until there is a cure. And it is essential that the Type 1 diabetes community holds the healthcare system accountable so that it provides coverage that works for all people affected by the disease.”

Beyond Type 1 stands alongside JDRF in denouncing UHC’s decision as unacceptable. Beyond Type 1 CEO Thom Scher stated “In the coming days and weeks, we’ll be partnering with JDRF to make clear to both UnitedHealthcare and other insurance providers that insulin pump choice ought be made by patients and their doctors, not by insurance companies. We hope that patients and advocacy organizations throughout the United States will join us in denouncing this decision as a step backwards for pump access, and for the T1D community more broadly.”

Currently the 670G is the only commercially available Hybrid Closed Loop system. That is expected to change this summer when Tandem launches Control-IQ which uses continuous glucose readings from the Dexcom G6. Although UHC did state that they will “have a clinical review process in place for prescribing physicians and members who feel a non-Medtronic device may be preferred” it is unclear what this review process will entail.

With more automated insulin delivery systems expected in the next two years from companies like Tandem, Lilly, Bigfoot and Insulet, it is vital now more than ever that patients are able to choose pumps and technology to best fit their individual needs.


#2

I wonder if he’s from Kowalski’s Market family. https://vimeo.com/281867954

https://www.kowalskis.com/


#3

Some of the fine print in the UHC document which was referenced by Mila above.

The MiniMed™ 670G system includes SmartGuard™ technology, which can be programmed to automatically adjust delivery of basal insulin based on Continuous Glucose Monitor (CGM) sensor glucose values, and can suspend delivery of insulin when the sensor glucose value falls below or is predicted to fall below predefined threshold values.

The Guardian™ Sensor (3) glucose values are not intended to be used directly for making therapy adjustments, but rather to provide an indication of when a finger stick may be required. A confirmatory finger stick test via the CONTOUR®NEXT LINK 2.4 blood glucose meter is required prior to making adjustments to diabetes therapy.

The original UHC decision from May 2016 that removed the choice for many UHC subscribers to choose a Tandem pump:

UHC_Medtronic_Fact_Sheet.pdf (272.7 KB)

The number one reason UHC listed (in the 2016 document) was:

Patient safety was a key consideration. The 2012 ASPIRE study found that pumps with a Threshold Suspend feature help reduce the frequency and duration of low blood sugar events.

Hey UHC !!! Surprise !!! Tandem released the Basal-IQ update last year. So, yeah, Tandem has that feature that you said was the reason why only Medtronic was allowed.

Oh yeah. BTW. The cgm integrated with the Tandem X2 Basal-IQ which will suspend insulin and resume based on cgm values, actually, does NOT require any confirmation fingersticks for making adjustments to diabetes therapy.


#4

I wonder if the same preference for Medtronic pumps holds true if one is on Medicare and UHC (Plan F) is the supplement.


#5

@Dave44 - I am about 85% sure this is UHC Commercial only.

Medicare / Medicaid is different and AFAIK, UHC has no similar restrictions for those. But also I don’t understand how “Advantage” works into the mix.

I actually find all that very confusing.


#6

Yep, I’m confused about it too. Just like when I try to get a price from OptumRX on a med. It says online “pricing not available”. How can they not know the price??


#7

Medtronic and UHG must have struck some deal. (Edited due to hostile content)


#8

Although one might say that is a bit crude…
Yeah.
I would have to agree with the sentiment.


#9

Maybe this will help…or not.

What I conclude is Advantage may cover more, may offer a all in one “feel”, but may also restrict things such as choice of pump mfg or brand of supplies, as an advantage to lower costs.


#10

Its unAmerican. (Edited due to offensive content)


#11

Concerning anyone but medtronic would be crude


#12

United Health Care and the Pharmacy Benefit Managers almost make the inevitable rigidities of Medicare for All seem a small price to pay near universal coverage.


#13

Medicare pays for the pump and supplies at the 80% level. I think that UHC F would be required to pick up the remaining 20%. Still a good question to verify.


#14

I’ve had time to reevaluate my position more thoughtfully. UHG and Medtronic are the real victims here. I’m sure they are doing the best they can. Perhaps Medtronic pumps are the only safe ones and we just don’t realize. I’m sure they have our best interests at heart. Plus, there may be laws coming into effect that say that they can’t just change the policy agreement regarding what they will and will not coverage, randomly, mid-year, after agreements have already been made with employers and patients. So, they may need to work quickly before laws change. My heart goes out to them for all the upcoming difficulties they may need to overcome.


#15

However, UnitedHealth Care Group Medicare Advantage Plans do not cover the Medtronic Guardian CGM System.


#16

Well, why would we need to know that the pump is working? We should be happy just to have one. Knowing if the pump settings make our BGs better or worse, could be perceived as important. But, its not a question that we can even answer without a CGM, so perhaps that’s best. Lots of people say the Medtronic CGM is no good, so either way…


#17

giphy%20(1)


#18

I am using the Tandem X2 Basal-IQ with Dexcom G6 integration and am happy to say that I haven’t had to resort to fingersticks in months!


#19

really?


#20

I have always heard that UHC was very bad for those with diabetes. BCBS doesn’t seem much better, at least here in NC. I am surprised they haven’t come out with a similar rule since they already restrict where we can by from to 1 supplier.