Access Gained by Losing Access

I wanted to take some time today to write about a conversation that I had with one of my HCP’s about the Medtronic / UHC deal. I have spoken about this deal multiple times with a lot of people and I’m not spending time now re-hashing the same crap over and over because, it’s spilled milk, the deal is in place and that’s that. Christel from The Perfect D had a great post on Facebook last night about moving forward, it is about what we do now.

I simply asked my HCP what she felt about the deal and this was her answer (summarized):

I don’t like that I have to tell someone who has United Healthcare that Medtronic is their only option, but I am really excited that I can tell someone who has United Healthcare that they can now get on an insulin pump and CGM and not have to worry about being denied coverage.

That is the part of this that I think a lot of people are not seeing.

Don’t even come at me with the #diabetesaccessmatters stuff because I agree with that cause and I agree 100% we need to have access to the products that we want that helps us manage our diabetes the best for ourselves.

But, let’s also take a step back from this and think about the people that just want an insulin pump, they don’t care what brand it is, they just want a pump that delivers insulin 24 hours a day.

Let’s be honest with ourselves here, all pumps are the same. They do the same exact thing. They deliver insulin.

One may have a cooler design or have a few extra bells and whistles, but at the end of the day, they all deliver insulin. So for someone who is looking for better control by getting off of MDI and switching to an insulin pump / CGM combo but they previously couldn’t because their insurance was denying them…. this deal is amazing to them.

I think the long term issue at stake here is an access problem, so I am glad that the access route is the way that the community came together and decided to follow.

But, I think we have to take a step back and think about what access actually means. Does access mean, just simply having access to an insulin pump (no matter what brand it is) or does access to you mean access to everything and you get to pick and choose what you want. Because, that is going to be a long battle that isn’t going to be solved today or tomorrow. No petition or boycott is going to solve that problem in the next 3-6 months.

Sharing your stories at DPAC will definitely help.

I know the hunger problem in the world may not be the best comparison, but it’s what popped into my head right now. But think about access to food. Sure, you can go into a restaurant and demand access to not just a T-Bone steak, but you want them to serve the Porterhouse too. While, right outside the window is someone just looking for any kind of steak, it doesn’t matter what it is.

And those are the people that have won in this deal between Medtronic and UHC and if we all truly cared about access, we would be acknowledging that as a win in the access category.

Now, was this the best way to do this? Give access to some people by taking access away from others?

No, absolutely not.

But that is why we as a community have come together and will continue to come together to figure out what those best solutions are. We have to come up with solutions, because if we don’t, we don’t provide any other options for companies and insurance companies.

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5 thoughts on “Access Gained by Losing Access

  1. Chris, it seems to me the mistake that UHC made was not having tiered pricing. But I assume they got enough concessions that it was worthwhile. For Medtronic, it is difficult for me to blame them at all. It is a strict business decision. I do not see it changing anytime soon for this deal.

    I referred your blog to the TUDiabetes web page for the week of May 9, 2016.

  2. It’s always tough to try to look at the issue not from a personal perspective (loss), but from a global one (net-gain). If UHC was indeed quicker to deny pumps before than they will be on July 1 (I don’t know this to be true or false), then there is an indisputable win for some people.

    Therefore, the question is about whether all pumps are fundamentally the same. Truthfully, I can’t bring myself to come to an answer on that one; I tend to sway with the wind on that topic. But what bothers me most is not the choice of pumps, but the larger pattern of who is empowered to decide medical treatments. If and when this expands to drugs, surgeries, etc.; being required to fail on a cheaper treatment before being allowed to proceed with a doctor-recommended (and more expensive) one could be very dangerous and have some serious consequences…. Much more serious than than that of a blue pump not matching a green dress.

  3. Rick – thanks for the comment. I agree with you that I don’t blame Medtronic at all for this because they are a business, but that’s a drum that’s been beaten to do death on my part. I appreciate you adding the post to the TUD page.

  4. Scott – thanks for your comment. There really are no numbers from either side in this, so really everything has just been speculation.

    When I say all pumps are the same, I mean that from a very basic viewpoint. They all deliver insulin right?

    Algorithms, IOB, temp basals, etc. those are all added features of pumps, but the benefit of them all is delivering insulin at a constant rate.

    The larger problem is where I believe every single person agrees on. I don’t think anybody out there argues that this is a much larger issue at hand than just an insulin pump. Christel had mentioned in a post that this was just the tipping point.

    And the issue with cheaper, less quality product is a reason why the Medicare Competitive Bidding program has failed. Which it all goes on the hands of the payers. They are the ones responsible for this and shouldn’t be cutting competitive deals. Any manufacturer is going to jump at this.

    I think that’s why the DPAC #SuspendBidding campaign is so important because it was speaking about this access issue before all the outrage bc of it being Medtronic.

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