An advocacy group for patients with Type 1 diabetes is calling out a new UnitedHealthcare policy that expands an existing agreement with Medtronic and makes the manufacturer's medical devices the "preferred" insulin pumps for children with the autoimmune condition.
Diabetes advocacy group calls UnitedHealthcare policy 'unacceptable step backward'
UnitedHealthcare policy could cut choices of insulin pumps for kids, JDRF says.
February 5, 2019 at 11:26AM
On Friday, Minnetonka-based UnitedHealthcare published a bulletin to health care providers saying the Medtronic product would become the preferred insulin pump for children age 7 and older who are receiving a prescription for an insulin pump for the first time.
The health insurer cited the safety, quality and cost of the Medtronic device in its decision, but the advocacy group JDRF called the new policy "an unacceptable step backward" because UnitedHealthcare is no longer covering all brands of insulin pumps for children.
"We don't think an insurance company should decide what kind of insulin pump a 7-year-old gets to use," said Cynthia Rice, senior vice president for advocacy and policy at JDRF. "We strongly oppose this new policy."
Patients with Type 1 diabetes also pushed back against an earlier policy established in 2016 by UnitedHealthcare, which made Medtronic insulin pumps the preferred devices for adults, too. The insurer at the time called the Medtronic device superior to others on the market, and UnitedHealthcare on Monday said patients using the product have had good results controlling blood sugar.
With the new policy, children who currently use a different brand of insulin pump can continue with that device, the insurer said.
The change effectively narrows insulin pump options from three to two, since there is no change to coverage for a "non-durable" pump that's on the market, UnitedHealthcare said. The other non-Medtronic pump is available if patients go through a clinical review process, the insurer said. If approved, the alternate device would be covered with in-network benefit levels through participating providers.
"Safety and helping individuals with diabetes avoid dangerous highs and lows in their sugar levels were the key factors in our decision," said Stephen Shivinsky, a UnitedHealthcare spokesman, via e-mail.
The new policy extends a novel collaboration between two of Minnesota's biggest names in health care, since Medtronic's operations headquarters are based in Fridley. While about 29 million Americans suffer from diabetes, in which blood sugar levels are above normal, the policy is critical to the much smaller group of patients with Type 1 diabetes, an autoimmune disease in which the pancreas stops producing insulin.
Based in New York, JDRF advocates for patients and funds research into Type 1 diabetes.
The group said in a statement Monday that insulin pumps are sophisticated medical devices, where different devices work better for different patients. So, patients and their doctors should maintain freedom of choice with pumps, the group said.
"We urge UnitedHealthcare to reconsider this decision," JDRF said in a statement.
UnitedHealthcare said nearly nine in 10 of all its health plan members who use insulin pumps currently use a Medtronic device.
While JDRF said it's concerned policies like that from UnitedHealthcare could stifle innovation, the insurer said it will review evidence that supports providing subscribers with access to new and advanced therapies to manage diabetes.
"If a patient and his/her doctor feel there is a medical need to use a non-Medtronic pump, we will work directly with the prescribing physician on the request," UnitedHealthcare said in a statement.
The paperwork burden for clinics in navigating rules to get treatments covered has become "enormous," said Dr. Antoinette Moran, a pediatric endocrinologist at the University of Minnesota. Moran said she hasn't had experience working with UnitedHealthcare's rules for getting access to nonpreferred insulin pumps, but such policies can work "as long as [the insurer is] willing to be flexible in circumstances where it just doesn't fit for the patient."
"All of the pumps and all of the sensors that are on the market right now are excellent," Moran said. But she added: "It's important that patients and care providers have the option of exploring everything available."
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