November 18, 2016 at 5:00 am ET
In the nearly 40 years since I graduated from medical school, a lot about being a doctor has changed. But one thing remains the same: the physician-patient relationship is sacred. And at the heart of that relationship is the ability to work collaboratively with patients, every day, to help them determine their best possible course of treatment.
Unfortunately, for older Americans living with Type 1 diabetes, Medicare has placed its heavy hand in the middle of this important relationship. November is Diabetes Awareness Month, a perfect time for Medicare to right a wrong.
In choosing not to cover one specific and popular insulin delivery pump, reimbursed by virtually every private insurance company, Medicare is dictating choice, rather than enabling patients to make these decisions based on their personal circumstances and the medical advice of their physician. In doing so, Medicare is creating two classes of patients: those with the means to access a unique treatment, and those who cannot.
This decision is especially troubling given that today, most patients with Type 1 diabetes have access to a wide range of treatments needed to manage their condition — a condition that requires them to find a way to provide the insulin their bodies need in order to survive. Many choose traditional portable insulin pumps, which infuse insulin under the skin continuously through a thin plastic tube to accomplish this goal, while others inject several times a day with needles.
A significant number choose OmniPod, which offers a different way of delivering insulin. This small tubeless device makes physical activities like swimming possible, which are more difficult for traditional pump users.
In refusing to cover it since it received FDA approval over 10 years ago, the Centers for Medicare and Medicaid Services (which operates the Medicare program) has given OmniPod a dubious distinction: it is the only FDA-approved insulin delivery system that Medicare patients cannot use unless they pay for it out of pocket.
As we now find in our current health care system, insurance coverage often dictates choice. It is especially true for older patients on fixed incomes who cannot afford to pay out-of-pocket for treatment — a group who are also more likely to be contending with multiple chronic conditions simultaneously. And it has long-range consequences for patients with Type 1 diabetes, as theirs is a condition which requires lifelong insulin treatment.
Medicare’s non-coverage policy decision effectively denies some of our nation’s most vulnerable citizens the ability to choose the treatment option that is right for them. Moreover, many OmniPod users who have relied on it for years while covered under private insurance are now forced to either choose an unfamiliar treatment or pay out-of-pocket when they become Medicare eligible. The scene is disturbing: imagine your parent or grandparent having to change an important medical treatment they’re comfortable with — and which keeps them alive — simply because they’ve turned 65. And this situation is not unique for this insulin delivery device; CMS likewise does not cover devices for continuous glucose monitoring with are routinely covered these days by all private insurance plans for patients with Type 1 diabetes using insulin pumps.
Medicare policy does not make fiscal sense; over time, the cost of the OmniPod is comparable to the already-covered standard insulin pumps. Congress gave Medicare the necessary authority: The legislative history of the Part D Drug Benefit under Medicare makes it clear that Congress anticipated new technologies would emerge and intended Part D to cover any insulin delivery device not covered under Part B as durable medical equipment. Medicare coverage for OmniPod has the support of every major patient group and medical society in the diabetes community, including the American Association of Clinical Endocrinologists.
And at a time when our politics have become more and more divisive, Medicare coverage of OmniPod is the rare subject which enjoys not only bipartisan, but bicameral support. Earlier this month, Sens. Susan Collins (R-Maine) and Jeanne Shaheen (D-N.H.), co-chairs of the Senate Diabetes Caucus, wrote to CMS Acting Administrator Andy Slavitt urging quick action. This is not the first time Congress has spoken — last year Reps. Diana DeGette (D-Colo.) and Ed Whitfield (R-Ky.) who, at the time, served as co-chairs of the House Diabetes Caucus, wrote to Health and Human Services Secretary Sylvia Burwell and Slavitt with a similar plea.
As a physician, I’m daily disheartened by our government’s intrusion into the physician-patient relationship in a way that limits access to innovative and effective care. And as an advocate, I’ve met far too many Americans who are suffering as a result.
For the patients who each and every day transition to Medicare, there is not a moment to lose. Which is why it is my desire — both as a doctor and as a diabetes advocate — that CMS correct these inequities quickly.
In doing so, people living with Type 1 diabetes throughout this country would be free to make the choice that’s right for them. And for doctors, we would be able to advise, support, and treat them the best way we know how: ensuring that the physician-patient relationship is, and remains, sacred.
George Grunberger, M.D., is chairman of the Grunberger Diabetes Institute. He serves as a clinical professor of internal medicine and molecular medicine and genetics at the Wayne State University School of Medicine, professor of internal medicine at the Oakland University William Beaumont School of Medicine, and as a visiting professor of internal medicine, First Faculty of Medicine, at Charles University in Prague, Czech Republic.
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