What is Actually Wrong with UHC choosing a Preferred Insulin Pump Provider?

MiniMed 530G Pump

I have to say, having type 2 I am faced with a generally uphill battle getting insulin pump and CGM technology to manage my diabetes.  With Medicare looming over me the high cost of these technologies are likely to mean that these options will be denied to me.  And what really makes me mad is that I believe that both of these technologies could be made much more affordable.  So when I see changes that might introduce more competition and sensitivity to costs into the system I am both excited and anxious.  The system is so horribly messed up that often these actions are disorganized, ill-conceived and destined for failure.  The latest is the announcement by UnitedHealthCare (UHC) (see page 7) that they are moving to have Medtronic as a their preferred insulin pump provider.

I have to say, I have somewhat mixed feelings about this subject.  It is my opinion that the healthcare free market is fundamentally broken.  And it is horribly broken for pumps.  Patients can’t make their voices heard with their wallets and payors (like UHC) who are in a position to make attempts at competition stumble with their in ability to understand what we as patients need.  We have had preferred options for years in drugs and even in certain medical devices like meters.  It hasn’t bothered us because in the end, if doctors and we as patients had important preferences, we could express those preferences by paying more money for a non-preferred option.  We wouldn’t consider a meter a “commodity,” most of us consider meters to be greatly differentiated by accuracy and usability factors yet we can work with preferred meters.  But we also have coverage for non-preferred meters.
There are some the key underlying forces at work.  Our healthcare system is attempting to introduce some form of competition, albeit often in an less than ideal manner.  This is what happened with Medicare and led to the suspend bidding debacle.  And UHC has failed to compete in key ACA marketplaces and is exiting.  As theWashingtonPost notes, the ACA has increased competition between insurers and one result is “Many insurers on the ACA marketplaces have responded by offering plans that keep costs down by narrowing their networks of providers.”  This isn’t some isolated incident, this is an industry wide trend and it has both good and bad consequences.  The good is that it may force pump manufacturers to compete on price which up until now they have not had to compete on price.  The bad is that it will mean less choice for our doctors and us as patients.  UHC is only one instance, it is likely that within the year we will see big portions of the insurance market make similar moves.

In the end, I actually think the problem is that pumps are treated as Durable Medical Equipment (DME) and not tiered as in drugs and other supplies.  Right now, the new policy will mean that if you have UHC and you choose a Medtronic pump it is covered, if you choose a pump from another manufacturer is to totally not covered.  This approach to insurance blocks the patient voice,  that is the real problem.  If insurance companies provided coverage for pumps with a “preferred” coverage but also provided some level of coverage for non-preferred pumps then the patient voice would be heard.   I think as patients we have to accept that in order for our voices to make a difference we have to be willing at some level to pay more for what matters to us.  And we also have to give the healthcare and payor system some level of freedom to use competition to make important factors play in the marketplace.  Unfortunately cost has not been an important factor in competition for pumps.  This is probably why we don’t have a $100 insulin pump.

I think we often have an initial defensive reaction to these sorts of announcements.  That we want things to go back to the way they were.  But in the end we have to move forward. I think the “ask” should be that having “No Coverage” for non-preferred providers removes medical decisions and patient choice in an inappropriate manner.  There isn’t a problem with a preferred provider, but non-preferred providers should be insured with a level of coverage that doesn’t simply take the non-preferred option off the table.   Obamacare means that insurers cannot refuse to cover those of us with diabetes or refuse us treatment and narrowing provider networks is a valid way of complying with Obama requirements.  And as the WashingtonPost notes, "this is a better way to contain costs than those the law forbids."  But simply not covering non-preferred pumps violates the spirit of the ACA since it denies us treatments.