UnitedHealthcare-Medtronic Insulin-Pump Deal Prompts Outrage

Miriam E Tucker

May 18, 2016

A major US health insurance company has announced it is going to restrict coverage for diabetes patients to just one insulin pump brand, which has prompted anger and concern from the patient and professional diabetes communities.

Earlier this month, UnitedHealthcare indicated that, on page 7 of a bulletin issued to healthcare providers, starting July 1, Medtronic would become the insurer's "preferred" durable medical equipment provider of insulin pumps for diabetes.

Patients won't be required to switch pump manufacturers right away, only after their current pumps go off warranty and no longer function properly. The decision doesn't apply to children under age 18, to continuous glucose monitors (CGMs), or to "disposable" pumps, including Insulet's Omnipod. The policy also doesn't apply to Medicare Advantage members or UnitedHealthcare Sierra Health and Life Commercial members.

UnitedHealthcare spokeswoman Kristen A Hellmer told Medscape Medical News, "Patient safety, service, and cost were key considerations in our decision process to partner with Medtronic, as we make a widely used and effective product available to our members while pursuing new ways to lower the cost of living with diabetes."

She cited the 2012 ASPIRE study, which found that pumps with a low-glucose threshold-suspend feature — currently available only from Medtronic — can help reduce the frequency and duration of hypoglycemic events (Diabetes Technol Ther. 2012;14:205-209).

Insulin pumps all work essentially the same way, but the brands differ in a variety of features, including insulin reservoir volume and delivery options, waterproofing, screen size and contrast, linkage with glucose meters/continuous sensors, download characteristics, and infusion-site options.

Asked his opinion, American Association of Clinical Endocrinologists (AACE) president George Grunberger, MD, expressed concern.

"AACE clearly would like to make sure there is freedom of choice and that patients and physicians choose what is best for the patient, not what one particular insurance company cut a deal to get," he told Medscape Medical News.

"To try to force patients and doctors into accepting a particular device like an insulin pump that might not be best for them just makes no sense clinically or otherwise."

It's a Matter of Choice

Other professional groups issued statements endorsing the concept of choice, without specifically naming the entities involved.

A statement posted May 10 on the American Diabetes Association's website said: "Partnerships between insurers and vendors that limit therapeutic choices may impair a patient's access to certain treatments and tools and adversely affect patient outcomes."

And a statement from the Juvenile Diabetes Research Fund (JDRF), which sponsors work on the artificial pancreas involving many device companies, says: "We know some insurers are putting in place agreements with drug and device manufacturers that put certain brands of drugs or devices on a preferred, in-network category, based on negotiations between the plan and the company.

"These and other market dynamics could affect innovation and access to [type 1 diabetes] therapies," the statement adds.

And on the widely read diabetes patient site diaTribe, founder and industry expert Kelly Close and her associate Adam Brown write: "Will more insurance companies move in the direction of [UnitedHealthcare] — exclusive deals on pumps and perhaps even CGMs, in the future? We certainly hope not, but it's easy to imagine this type of agreement spreading."

Patients Express Outrage on Social Media: #DiabetesAccessMatters

Meanwhile, patients with type 1 diabetes are expressing outrage on social media, using the hashtag #DiabetesAccessMatters and #MyPumpMyChoice among others.

"Medtronic needs to be in the market, but does not need to be the market," Twitter user and type 1 diabetes advocate Wes Ton @WeAreNotWaiting tweeted last week.

And an online petition, "Get United Health Care to Cover all Insulin Pumps," has thus far garnered nearly 5000 signatures.

Ms Hellmer told Medscape Medical News that exceptions will be possible. "UnitedHealthcare values the relationship between patients and physicians and recognizes that different options are sometimes needed. We will have a clinical exception process in place and will work directly with the prescribing physician to evaluate any instances in which he/she believes a non-Medtronic pump may be required."

Dr Grunberger said, "Obviously, I'll do everything possible in my practice to make sure patients get what the patient and I decide, not the insurance company."

Dr Grunberger conducts research for Novo Nordisk, Eli Lilly, AstraZeneca, Sanofi, Lexicon, and Medtronic and is on the speaker's bureau for Novo, Lilly, Sanofi, and Janssen Pharmaceuticals.

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