Insulin-pump limits worry patients

Starting July 1, many UnitedHealth clients will face fewer choices

Stephanie RodenbergLewis wasn’t happy with her insulin pump and finally switched two years ago to another brand. Now her health insurer is pushing her to go back.

UnitedHealth Group has made a deal with device maker Medtronic that will slash options for diabetics who use the portable pumps, which costs thousands of dollars. The move has angered RodenbergLewis and others who will be limited to three pump choices instead of nine.

Health insurers, big employers and other bill payers have been trying for years to rein in costs and improve care by steering clients to certain doctors and hospitals. They’ve also restricted options for some prescriptions and lined up deals for smaller-ticket items like diabetes test strips or items patients don’t chose, like heart stents.

Limiting choice for medical equipment that a patient usually selects is uncharted territory. UnitedHealth rivals Aetna and the Blue Cross-Blue Shield insurer Anthem say they haven’t done this. But experts say it could become more common.

Insulin pumps are pager-size devices used mainly by people with Type 1 diabetes, the kind often found in childhood. These patients can’t make their own insulin, the hormone that turns food into energy. The external pumps make up for that by delivering a steady dose through a tube into the skin or a patch and extra doses at mealtimes

Starting July 1, customers on many of UnitedHealth’s plans will only be able to choose between two Medtronic pumps or an option made by Insulet. If patients want another brand, they may have to pay some or all of the cost. The insurer says it will make exceptions for patients who have a medical need for another option.

These systems can cost $5,000 or more.

The nation’s largest health insurer says it wants to steer patients toward quality devices that are competitively priced.

Patients may see insurers making more deals like this in the future, said Linda Blumberg, a health economist with the nonprofit Urban Institute. She thinks it could push other companies to cut costs and make improvements to land their own deals.

Regulators, though, must make sure it isn’t too hard to get other options, if they are medically needed, she added.

“We can’t just wish away the high cost of medical care,” Blumberg said. “We’ve got to think about ... ways in which we can bring down costs while not significantly hurting quality.”

Patient advocates say all the pumps on the market deliver insulin safely. But they worry that these agreements will force patients to live with a pump that may not be right for them and hurt competition by pushing smaller manufacturers out of business.