UnitedHealthcare Chooses Medtronic as Preferred Insulin Pump Provider, Starting July 1
By Adam Brown and Kelly Close
Insurance company UnitedHealthcare has chosen Medtronic as its preferred insulin pump supplier, starting July 1, 2016. Once the policy goes into effect, adults (18+ years) with United insurance will only be covered for a new Medtronic pump – eliminating patients’ ability to get a Tandem, Animas, or Roche pump. (As we understand it, Insulet is excluded from this decision.) The policy does not apply to children 18 years and younger, or to United Sierra Health, Life Commercial, and Medicare Advantage plans. Read the full details here (page 7).
If you are currently on a non-Medtronic pump and have United insurance, this news has no immediate impact. Your pump supplies will be covered as long as your pump is under its four-year warranty and still functioning properly. Once your pump goes out of warranty and/or breaks, however, you will be required to switch to a Medtronic pump.
If you currently have United insurance and plan to switch to a non-Medtronic pump soon, you will need to: (i) change to a new pump before July 1; (ii) change insurance companies; or (iii) work with your provider to convince United that a non-Medtronic is best for you (generally, this means filing an “appeal”).
If you currently have United insurance and do use a Medtronic pump, or you plan to get on a new Medtronic pump soon, this news might bring faster paperwork processing, less administrative hassle, and potentially lower co-pays (United has not confirmed this). To be the only pump offered by United, Medtronic presumably offered a meaningful price discount. In this case, we’re not sure if any of those savings will be passed on to patients (all plans are different, but we haven’t been able to learn anything from United).
Exclusive agreements are very common in pharmaceuticals, particularly across similar drugs. Sole source deals have been in effect for years in diabetes, including in insulin and blood glucose monitoring. But not all insulin pumps are the same, and it would be beneficial for many patients and providers to have broader choice among all the available options, particularly for patients doing very well on one brand of pump. Many people with diabetes have already expressed displeasure on social media (#DiabetesAccessMatters on Twitter, for example).
This news might also be negative for the broader diabetes technology field, which needs more investment and friendly competition to bring patients better products at lower costs. Exclusive payer-manufacturer agreements are less favorable to smaller companies, which impacts medical devices because many valuable breakthroughs come from young and nimble companies. Will more insurance companies move in the direction of United – exclusive deals on pumps, and perhaps even CGM, in the future? We certainly hope not, but it’s easy to imagine this type of agreement spreading. Patients are definitely excited about Medtronic’s innovation (e.g., the MiniMed 670G hybrid closed loop), but they do appreciate choice and seeing contributions from many players. We hope this decision isn’t a sign of things to come, particularly as many companies compete to automate insulin delivery. We want to see a thriving commercial environment in diabetes, especially in areas that are under pressure to survive.
Additionally, we’d love to learn more about patient input in decisions like this. How could patients collaborate with payers and be represented in the decision-making process? How does United think patients could help reduce costs? What have patients successfully done in other areas? Overall, we’d love to see a more transparent process to better understand UnitedHealthcare’s goals for people with diabetes and their providers. Please see the open letter to the payer community we have drafted in tandem with other partners in the diabetes advocacy community here.
Read UnitedHealthcare’s Decision on page seven here. The preferred relationship excludes UnitedHealthcare Sierra Health and Life Commercial members, as well as all UnitedHealthcare Medicare Advantage members. UnitedHealthcare members who are 18 years old and younger may remain on their current insulin pump and are not required to use a MiniMed pump.