On February 1, 2019, UnitedHealthcare (UHC) announced a significant change to its insulin pump coverage policy, as it will no longer cover all brands of insulin pumps for children. Instead, the nation’s largest insurer has selected Medtronic as the preferred brand for those age 7 or older who go on an insulin pump for the first time.
Breakthrough T1D is voicing strong opposition to this policy, and you can read more on our position here. As an organization started by parents of children with type 1 diabetes (T1D), we deeply understand the emotions that can come as a result of limiting choice in therapies for children. What works well for one person with T1D simply does not always work well for another – and any agreement that limits choice only adds to the already overwhelming burdens of life with T1D.
To help with what these new changes mean as we currently understand them – as well as how you can join Breakthrough T1D by sending a message to UHC that less choice for children is unacceptable – see the below FAQs prepared by Breakthrough T1D’s Advocacy team.
What does this change mean for UHC members? It will be more difficult for people with coverage through UHC to obtain insulin pumps recommended by their doctors if it is not the preferred brand. UHC indicates that if an individual is currently on a non-Medtronic pump, their supplies will continue to be covered. It is not known what UHC will do if such pumps break or if the user wants to replace them after their warranty has expired.
How does this impact users of Tandem and Insulet pumps? Anyone with diabetes who has UHC insurance and is age 7 and older will need to obtain approval through a clinical review to get their Tandem pump covered. UHC has indicated they will continue to cover the Omnipod as they currently do. This would mean that people wanting coverage for the Omnipod must complete a prior authorization and will be subject to whatever cost sharing is required under their specific benefit design.
Is it possible to be exempt from this policy? It is Breakthrough T1D’s understanding that a small proportion of such requests have been approved for adults and that it can be helpful to have your employer contact UHC on your behalf if you pursue this route. For help with applying for an exemption, see Breakthrough T1D’s Health Insurance Guide.
Does this policy change anything for UHC’s adult members? The current policy for adults — which has Medtronic as the preferred insulin pump — remains in place. The new change directly impacts children ages 7-17, who did not previously have restrictions related to a preferred brand of insulin pump. Essentially, the restrictions that have been in place for those age 18 and older now also apply to those age 7 to 17.
Why is this change a significant step backwards? The use of diabetes technology like insulin pumps leads to better outcomes for T1D, and this is especially critical for children so that they grow into healthy adults. Insulin pumps are sophisticated medical devices that save lives — and different ones work best for different people. For example, someone who suffers from dangerous low glucose episodes may benefit from a pump system that could alert family and friends. Moreover, some individuals may benefit more from certain algorithms that adjust insulin delivery or a pump without tubing.
Are restrictions like these common? UHC is an outlier. Thanks to advocacy by the T1D community as part of the Breakthrough T1D Coverage2Control campaign, other large insurance companies cover all approved insulin pumps. Breakthrough T1D advocates for insurers to cover all brands of critical diabetes care therapies, including insulins, test strips, continuous glucose monitors, and closed loop systems.
Hasn’t UnitedHealthcare done good things for our community, too? When UHC has made policy decisions that benefit the T1D community, we have acknowledged and thanked them for those actions. However, we do not agree with this latest decision which restricts access to insulin pumps for children, as we feel that it is detrimental to the T1D community.
Breakthrough T1D has publicly and privately praised UHC for actions that they have taken that directly benefit the T1D community. Most recently, UHC announced that for people in fully insured employer plans, they would pass rebates for drugs like insulin through to the point of sale, directly reducing the price paid at the pharmacy counter. As part of the Coverage2Control campaign, we have sent thousands of letters thanking them for taking this action and our CEO followed that up with a personal letter to UHC’s CEO expressing our gratitude. We also thank them for covering the Medtronic 670G, as we agree that this device is a safe and effective insulin delivery system and should be available to any person with T1D who wishes to use it.
However, Breakthrough T1D believes that UHC’s insulin pump agreement with Medtronic is an unacceptable step backward in giving children with T1D what they need to manage their disease and stay healthy. Every person with T1D, no matter their age, should have the freedom to decide which insulin pump is right for them — this is not a decision that should be made by an insurance company. We are also concerned that this decision may stifle future innovation in the diabetes devices market. We would be just as critical of a policy by any other insurer that so limited choices in therapy options for people with T1D.
Do any of these affected companies give Breakthrough T1D funding, and does that impact Breakthrough T1D’s stance? Corporate donors to Breakthrough T1D do not influence the Breakthrough T1D decision-making process. Our research allocations are vetted by an independent committee of experts who invest in the most promising research. Breakthrough T1D is, and always has been, governed by people who have strong personal ties to our mission. We are parents of children with T1D or people living with the disease, and we are deeply committed to running an efficient organization that strategically directs donor dollars to make the largest impact as quickly as possible.
Our health policy priorities are focused on advocating for coverage, affordability and choice of T1D therapies, irrespective of manufacturer. Breakthrough T1D has publicly reported our donations from various companies and that information is available on Breakthrough T1D.org.
What is Breakthrough T1D doing to respond to UHC? Breakthrough T1D is publicly urging UHC to reconsider this decision. Coverage, affordability and choice of therapies are key components of our mission to improve the lives of people with T1D today, until there is a cure.
How can the T1D community take action? Breakthrough T1D is aggressively spreading the message that insurance companies shouldn’t choose what insulin pump a child – or anyone with T1D – uses. Join us by telling UHC to give people the freedom to choose the insulin pump that’s right for them.
- Click here, and you’ll find a pre-written letter that will go directly to UHC and urge them to reconsider their decision. Add a personal comment if you wish, and within seconds, send them a message that limiting pump choice is wrong.
- Once you’ve sent your letter, share your support on social media by clicking on the Facebook or Twitter icons to generate sample posts. And if you or your family have UHC insurance and are interested in speaking publicly about this issue, email advocacy@BreakthroughT1D.org to join our efforts.
Stay tuned for updates as we continue fighting on your behalf to ensure people with T1D get the coverage they need.
