Wednesday, May 4, 2016

#MypumpMychoice #AccessMatters: I Didn't Choose To Have A Preferred Relationship With Diabetes

By now everyone is talking about UnitedHealthCare and Medtronic’s partnership and the press release that states in part: 
“As part of our ongoing efforts to provide a better member experience, while increasing quality and lowering the overall cost of diabetes care in the United States, UnitedHealthcare has reached an agreement with Medtronic to become the preferred, in-network durable medical equipment (DME) provider of insulin pumps for UnitedHealthcare Community Plan and Commercial members, effective July 1, 2016”
UnitedHealthcare will continue to pay for pump coverage for others brands until those pumps are out of warranty - and once that happens, customers will either have to switch to Medtronic or pay out of pocket for the pump of their choice.

You can read the Press Release in its entirety, HERE, and I highly suggest you do because it's important, no matter which insulin pump you wear, or don't wear - or whether or not UnitedHealthCare is your insurer.

FTR and not surprising, UnitedHealthCare doesn't don’t provide a direct link. Scroll down to “Front and Center,” and click on the 5th bullet point where it says “Medtronic to become preferred DME Provider of Insulin Pumps for Diabetes, Effective July, 2016.” 

I currently wear an out of warranty Medtronic Pump. That’s my choice - and yes, my insurance has a coo-coo high deductible, only partial coverage once crazy high coo-coo deductible is met, and ridiculous amounts of paperwork and labs to prove that yes, “I actually do have diabetes and require a new insulin pump.” 
And all of which make it anything but easy for me to get a new pump - but at least I get to choose said new pump when I actually get one. 

Here's the thing: It’s not like I chose to have a “preferred relationship with diabetes,” over a perfectly functioning pancreas. I didn’t have a choice when I was diagnosed with t1 diabetes almost 4 decades ago, and ever since my choice to live sans D was taken away, having choices in my life has become of paramount importance. 

Choice when it comes to how I live my life. 
Choice when it comes to my body.
Choice when it comes to my diabetes and the tools and methods I use to manage my diabetes.

And slowly, my (and by “my”, I mean OURS - EVERY SINGLE PERSON LIVING WITH DIABETES,) diabetes choices are being compromised and whittled down and have been for years - and that’s bullshit. 

This isn’t just about insulin pump choice - a choice that is both intimate and personal, since we wear them almost 24X7. 
It’s about not having a choice in the future when it comes to CGM choices, Artificial Pancreas choices, insulin, meters and test strip choices - as well as choices regarding insulin pumps - and coverage (or the lack there of,) for all of the above.

This move reinforces the thinking that diabetes is a one size fits all, disease. 

Diabetes isn’t once size fits all disease. Different strokes for different folks, for a disease where 95% of the day to day treatment is in OUR HANDS.

 94 years ago, insulin hit the scene and saved millions of lives -imagine if we still only had access to one type of insulin? 
Crazy, dangerous and unacceptable - to be perfectly frank, we’d be F^cked. 
Same goes for insulin pumps. 

I won’t demonize Medtronic - I have friends who work there with families and mortgages. 
Medtronic as an insulin pump has worked well for me since 2002. 
And my mother was one of the first people on the east coast to have an implantable defibrillator in 1991 - it gave my family an additional 20 years with my amazing mom and I will always be grateful.  

I don't find Medtronic pumps to be an inferior product, nor do I find insulin pumps made by other companies besides Medtronic to be inferior. 

But I won’t ignore the fact that this move is disturbing, sets precedents that don’t benefit patients, and has ramifications  that will adversely effect every PWD for years to come.

As a person with diabetes, I already know Pharma sees me as many things. 
As an Opinion and Thought Leader, a tool to communicate to the masses, and as a dollar sign.

And I'll cop to being all of the above. This dollar sign has a voice - And I’m not afraid to share my thoughts on what I believe is right…. and what I believe is wrong. 

This move is wrong and it hurts a lot of people on both sides. 

I’m asking both Medtronic and UnitedHealthCare to reconsider. 

I’m asking you to use your voice regarding this decision because your voice is so damn important. 

Together, the Diabetes Online Community moves mountains. Alone, we trudge up hills. 



Scott S said...

My perspective is that insulin pumps are fundamentally no different than which brand of insulin someone uses or what brand of testing supply someone uses, both of which have "preferred" formulary brands. Personally, I cannot use Novolog insulin (I call it slow-moving log it's so slow for me), I'd prefer regular over that because it's the same speed for me. One can challenge anything they need, but I don't think United Healthcare is any worse for this decision than they are for switching insulin brans, meter brands, etc.

k2 said...

Scott -
You're absolutely entitled to your opinion, but I have to respectfully disagree.
I believe that patient should be given a choice, not limited to one brand/option.
For instance, my insurance allows me to choose from Apidra, Novolog, and Humalog, which is great. however, my insurance will only cover 50% of the above insulin because indulin doesn't come in a generic form. But I have choices.
If patients and their healthcare providers don't have a choice in the form of options re: their diabetes treatment, no good will come of it.

Rick Phillips said...

I am not upset with the decision because it certainly is within the scope of insurance and manufacturers to make this decision. We have it every day in terms of preferred medications and pharmacies.

My complaint is that this is a short-sighted decision. We need many products in the market and more innovation than less. Deals like this limits both, and for my money the insurance company is being very short sighted. We need to UHC know that we are willing to express our discontent. Looks like we are.

I referred your blog to the TUDiabetes web page for the week of May 2, 2016.

Scott S said...

K2, I'm not saying I disagree, only that the arguments I've heard against the decision have yet to persuade me. I am annoyed that no one argues the same issue on testing supplies, when the reality is that there can be some legitimate accuracy issues, but the patient community is pushing on those issues so I do see some collaboration. But anyone who claims there's much choice in insulin, testing supplies or pumps hasn't been observant to the issues that have become significantly more pervasive in recent years with formulary brands, tiered pricing and a host of issues getting in the way of true choice. As I said, I can be convinced, but so far, none of the arguments I've heard has persuaded me, but perhaps someone can present those and I'll be persuaded. Remember, I'm on the side of the patients here!

k2 said...

Scott -
Oh, people have been talking about limitations on meters & strips, and it's absolutely a problem - which will be exacerbated by UnitedHealthcare''s move to only allow for one type of insulin pump coverage.
Limiting the choice of him insulin pumps will also limit the choice of CGMs, and I in my opinion, will limit the technological advances when it comes to diabetes – especially regarding the artificial pancreas.