UnitedHealthcare Decision — A Step Backwards for Pump Access
Editor’s Note: Add your voice + speak out against the recent UHC decision by sending a letter to UnitedHealthcare. This tool from JDRF makes it easy.
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.