The issue: UnitedHealthcare insulin pump restrictions

As a community, we are committed to enhancing the lives of all individuals living with diabetes, which necessitates easy access to therapies and technologies. Making the healthy choice the easy choice is a key part of success with this condition and payers and governments can play an enabling role in that quest by following these principles:

  1. There is no one-size-fits-all solution for diabetes. Patients are incredibly diverse, spanning all ages, all income levels, and all ethnicities.
  • How can payers amplify a wide-range of patient voices, particularly those struggling the most to manage their diabetes?

2. People with diabetes want to have a productive dialogue with insurance companies and governments about access. Improving the patient experience will benefit patients, providers, payers, and governments. Sharing perspectives will ensure people with diabetes have an opportunity to have optimal outcomes and high quality of life.

  • How can the diabetes community and payers begin an open dialogue? What elements are important to sustain and strengthen an open dialogue?

3. Direct patient feedback seems to be missing when major payer decisions are made. Hearing patient stories is incredibly instructive. Diabetes is 99% self-managed, and for people on insulin, this means dosing a potentially deadly drug every day. Type 2 patients who take the most commonly prescribed drugs are at high risk of hypoglycemia every day as are all people with diabetes on mealtime or long acting insulin. We believe payers will learn from hearing directly from patients before making major coverage decisions.

  • How can payers reach out to the diabetes community before making major coverage decisions?
  • Have patients been asked to join conversations about reducing system costs?
  • As an aside, direct patient feedback seems to be missing in minor payer decisions as well leading us to wonder if there is appetite to hear the patient voice.

4. Low-cost, low-hassle access to a wide variety of diabetes drugs and technologies can save patient lives and make healthcare providers more efficient and more successful. Too often, patients and providers must jump through ridiculous hoops to get access to therapies or worse, they simply give up.

  • How can payers reduce the hurdles to obtaining diabetes drugs and technologies?

5. Open competition between diabetes companies may prompt faster innovation and lower prices. Although we understand the competitive dynamic and the need to reduce prices, patients are concerned about single-source diabetes contracts in diabetes that limit choice to one therapeutic option because these products are complex, and shifting patients to different products can result in weaker diabetes management.

  • Can payers promote a healthy commercial environment where multiple companies can compete and succeed?
  • Are payers concerned about any fields (e.g., insulin pumps) where there is risk of small companies (e.g., Asante) going out of business and being left with one manufacturer who could then increase prices?

6. There is an opportunity for payers to support the patient-doctor relationship by understanding the environment in which physicians and nurses are working today. Diabetes could improve if payers work with patients and providers toward a better patient and provider experience.

  • There are a multitude of prescribing hassles.How well do payers understand the day-to-day experience of providers including what happens when patients go home?
  • How well do payers understand patient-doctor relationships? How do payers think they could help make these more productive?

7.Patients could help prevent system waste and reduce system costs.

  • Have payers engaged patients in such a discussion?

8. Patients would appreciate if payers would think beyond A1c as the only outcome of importance in diabetes. Hypoglycemia, time-in-range, daily burdens, stress, worry, and guilt are not reflected in A1c but they can be very important to our success as patients.

  • How can payers expand outcomes beyond A1c to include other measures that matter to people with diabetes?