It's deja vu for the Diabetes Community.

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Just like they did nearly three years ago, Medtronic Diabetes and UnitedHealthcare have announced a new deal that makes that brand of insulin pump -- and the Minimed 670G hybrid closed loop system in particular -- the "preferred in-warranty pump" for those with UHC health insurance getting a pump for the first time. This mirrors what the two companies did in May 2016 for adults, now that the 670G (last summer) snagged FDA approval for use in kids as young as 7.

This policy revision took effect Feb. 1, 2019, tucked into page 10 of a 59-page policy update that went out to the UHC network and medical professionals. While the new policy doesn't technically cut off access to other brands, it's expected to have that practical effect just as the 18+ population has experienced in the past few years. Many in the D-Community say they've had their choice taken away, because the insurer or pump reps have aggressively pushed the preferred brand, or a doctor hasn't been willing to spend the extra time needed to fight for a different brand device despite the patient's wishes.

The two companies emphasize that insured customers currently using non-Medtronic pumps can remain on their existing warranty and they'll continue to be covered -- and that any individual member who wants a non-Medtronic device can go through a UHC clinical review process, and if approved, can secure in-network coverage for that other pump.

Both JDRF and Beyond Type 1 advocacy orgs responded within days of the announcement, issuing strongly-worded opposition letters that describe this as "an unacceptable step backward" on choice -- urging UHC to not only change its mind now, but to show a coordinated response in hopes that other insurers won't follow suit with this preferred pump brand move. We do wonder what will be different this time, considering little changed after protests the first time around.

 

Here's What You Should Know:

  • This policy only applies to traditional insulin pumps. It does not apply to Insulet's OmniPod, which is the only tubeless pump on the market for which UHC added coverage last year.
  • Supplies for existing in-warranty pumps won't be affected, meaning you get can still in theory get the needed supplies for your non-MedT pump as long as it remains in-warranty and is working (basically Tandem, since Roche and Animas pumps have been shelved and supplies are now routed through MedT). However, once it's time for a new insulin pump, all bets are off.
  • Exceptions may be made. The policy states that patients may still be granted coverage for non-Medtronic pumps on a case-by-case basis, determined by a TBD set of clinical indications that we've yet to see outlined anywhere. If granted an exception, the member can get in-warranty coverage for that non-Medtronic pump through an in-network distributor (meaning it wouldn't necessarily amount to a higher cost, but since insurance plans vary with each carrier, that remains to be seen).
  • It seems the only way for patients to fight for the pump of their choice is to work with their doctor to show evidence of "clinical critieria" indicating that a pump other than Medtronic is needed.

Here's where the rubber meets the road, Folks. Sure, there may be limited exceptions that UHC and Medtronic can point to as evidence that access isn't limited. But that's disingenuous, whether intentionally or in a tone-deaf way, because it's not how patient access works in the real world.

In the real world, patients face significant barriers:

  • Insurance company reps at call centers often tell people that Medtronic pumps are the only ones covered, without mentioning the option to technically wage a battle to get a different device. Third-party distributors do this, too. They know that most people will take the term "No Coverage" at face value and give up.
  • Pump company sales reps are often aggressive, and will ignore that detail as well. This is true of both Medtronic reps, and reps from other companies who in the past three years have simply ended conversations when finding out a potential new pumper has UHC coverage.
  • Doctors, endos and clinics often aren't willing or able to go through the extra hoops to get insurance coverage for a non-preferred device. This is unfortunately a growing trend as more healthcare professionals (HCPs) just don't have the time to spend on the extra paperwork and hassle, amidst their own decreasing reimbursement from payers.

As a result of all this, the net effect of this UHC policy -- and really any "preferred" agreement -- is that our access is limited and choice is taken away. These companies are essentially manipulating the market to eliminate competition and customer choice in a cartel kind of way -- and that's NOT OK.

 

UHC and Medtronic's POV

Interestingly, before this was announced on Feb. 1, both Medtronic and UHC reached out proactively to us at the 'Mine (as well as to others in the Diabetes Online Community) to ostensibly give us a goodwill heads-up. They claimed to have "learned a lesson" from the DOC response a few years back. Honestly, we don't see that. Just alerting people a day before the news is public doesn't make for fair play; it's just PR ahead of time. There is still an incredible level of tone-deafness here that clearly hasn't changed for either company since 2016.

Medtronic definitely doesn't seem to get the message (or care) that many patients are deeply unhappy with this move.

Meanwhile, as expected, UHC puts a positive spin on the whole thing. Corporate Communications VP Stephen Shivinsky tells us:

"We understand the important role pump choice plays in an individual’s overall management of their diabetes. We recognize that different pump options are sometimes needed based on an individual’s unique needs, and value the relationship between patients and physicians in evaluating those options." He points to the clinical exception process that UHC plans to make "as simple and efficient as possible."

He adds that 88% of existing UHC member pumpers on pumps currently use Medtronic pumps anyway, and that everyone will continue to have access to new innovations and tech. UHC will review any published, peer-reviewed clinical evidence that supports members' access to new, advanced therapies to help manage diabetes. However, we challenge UHC to just browse the Internet to see all the posts from adult 670G users who say they're unhappy with the pump and feel forced rather than being able to use other devices. It's not an uncommon theme online.

Medtronic isn't being short-sighted here, Folks. They know, just as we all do, that there's new D-tech on the horizon in the coming year or so that will offer real competition (and may very well outshine) to their 670G. Take the Tandem Control-IQ hybrid closed loop system under development, that's expected around to be the next to get FDA approval around mid-year and hit the market. Medtronic is trying to grab as many customers as it can before then, and it's also locking in its insurance coverage advantage ahead of the near-term competition.

It's also worth noting that in mid-2018, Medtronic put a bold "value-based insurance design" program into place that includes offering to pay for any DKA hospitalizations among patients using its 670G.

The fact that the 670G is the only commercially-approved device of its kind on the market currently means that Medtronic has a big head-start in proving its offerings are the most advanced tech, and it's scrambling to use that advance to make deals with payers. Unfortunately, this contributes to the already uphill climb for smaller competing pump companies like Tandem to convince payers like UHC to change policies in the coming year or two.

 

The Diabetes Community Responds

Much like before, the DOC lit up when hearing about this latest UHC-MedT deal. There were hundreds of responses online in just the first day after the weekend announcement. Many of the cries point to the familiar protest agains "non-medical switching," i.e. how insurers should not dictate treatment decisions over the recommendations of doctors and their patients' wishes. This type of policy essentially trumps the patient-physician decision making progress -- even with the exemption criteria the companies cite.

We asked JDRF and Beyond Type 1 why they believe this time is different in calling for change, considering UHC and Medtronic did not change their policy after the fulss in 2016. The JDRF specifically says that as a result of the campaign that arose from this a few years ago, the org has been able to meet with 24 (as in two dozen!) other large health insurers and urged them to not follow UHC's lead -- something that was successful, in their view, because other insurers haven't made these exclusive agreements on different pumps to date. Also, the JDR says that as a result of those access-related conversations, UHC did agree in 2018 to add OmiPod to its in-network covered devices -- and the only tubeless pump currently remains exempt from this MedT arrangement.

For its part, Beyond Type 1 says the prior response from the DOC was less aggressive and took time to materialize, whereas as this latest development can bring a stronger call for change.

"We’re hopeful UHC will reconsider," BT1 CEO Thom Scher says. "Separately, it is also critical that other insurers, beyond UHC, see an overwhelming response from advocacy organizations and patients."

 

So What Can We Do?

We're grateful to our D-advocacy brothers and sisters in arms who've taken up this most recent charge, recommending the actions listed below.

Remember, you don't have to be an UHC insurance customer for this to impact you. It has implications for ALL of us, so please raise your voice and let UHC -- and also your own insurance company -- know that we find this unacceptable!

  • Share our stories! We need to express how this access issue impacts people, and share those experiences with health insurers, diabetes device manufacturers, medical professionals, and elected officials. Media stories are already in the works, we hear, and the JDRF has also created a site where you can easily create and send a letter to UHC about this issue: Click here to send a letter.
  • After the original 2016 UHC-MedT announcement, the Diabetes Patient Advocacy Coalition (DPAC) created an online hub to facilitate this story-sharing. Visit DPAC's Access Matters to share your own thoughts.
  • Reach out directly to UHC and tell them how you feel. You can reach UHC and its parent group UnitedHealthGroup on Twitter at @myUHC and @AskUHC. Or write a letter or make a phone call to their execs.
  • Do the same with Medtronic, letting them know you aren't happy with these exclusive agreements and that you'd like to see them nix any others that may be in the works. Reach them at @MDT_Diabetes or at Facebook.com/MedtronicDiabetes.
  • Talk to your diabetes care team about this, too! This insurance mandate on insulin pumps means it becomes more work for you and your medical team to get the device you want. So let's help physicians and educators understand what's happening and encourage them to echo these concerns up the chain.
  • Advocate to employers and insurance brokers. Employees with workplace health plans can take their advocacy to HR and/or directly to the company's insurance broker, who often have effective channels to communicate back to these payers (insurance companies). If enough employer health plans start raising this exclusivity issue with UHC and other insurers, maybe they'll rethink any policy change decisions impacting patient choice.

We at the 'Mine are clearly passionate about freedom of patient choice and unrestricted access to diabetes tools. It is simply an ethical imperative to let patients with a chronic illness access a variety of existing treatments to stay as healthy as possible!

Listen up, UHC and Medtronic: Stop forcing our hands and making us spend yet more time and energy fighting to get what we need to lead healthy lives.