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Does United Healthcare Cover Insulin

Unitedhealthcare, We Need Insulin Pump Choices

Unitedhealthcare, We Need Insulin Pump Choices

In its May bulletin to healthcare providers, UnitedHealthcare (@myUHC) announced that, starting July 1st 2016, Medtronic would be its “preferred” in-network provider of insulin pumps for its adult customers with Type 1 diabetes. This means that, with a few exceptions, if you’ve got Type 1 diabetes and health insurance from United, your next pump is going to be Medtronic. And since United is the nation’s largest insurance company, it’s conceivable that other insurance companies will follow suit. The policy, which unfortunately is already in effect, is bad news for people with diabetes. Equally unfortunately, United appears to have made its decision without input from people who actually wear insulin pumps. This was a mistake. Many diabetes advocates have already written about this issue (for example, see here, here, here). I’m weighing in here with my own response, to do what I can to help the United executives in charge of this decision understand why we are so upset, and to encourage them to reconsider the policy. The cynical view of the situation is, of course, that this was purely a financial decision—that Medtronic offered a big enough discount for being the “preferred provider” that United decided it was worth it to restrict coverage, whether or not the decision was beneficial for people living with diabetes. My hope, however, is that the UnitedHealthcare executives who made this decision have actually been surprised by the outcry their new policy has provoked. In addition to whatever discount they’re getting from Medtronic, I would like to think that they also are motivated by a genuine desire to provide access to good care. Either way, it’s reasonable to assume that the people in charge of the decision were presented with data about how the Continue reading >>

Unitedhealthcare Restricts Insulin Pump Choice: The Diabetes Community Responds!

Unitedhealthcare Restricts Insulin Pump Choice: The Diabetes Community Responds!

As insurance companies are increasingly maneuvering to restrict patient choices on all types of diabetes devices and medications, the latest move by UnitedHealthcare to make Medtronic its exclusive in-network supplier of insulin pumps has outraged the patient community. News of this UHC change came on Tuesday, with Tandem Diabetes Care being the first to put out a press release calling attention to the new policy, stating that as of July 1, 2016, adult PWDs (over age 18) covered by UnitedHealthcare will have a much more difficult time obtaining a new, non-Medtronic brand of insulin pump. What's especially frustrating is that UHC buried the information about this change on Page 7 of a 31-page document sent out recently to doctors and patients. It took an industry competitor to blow the whistle, as it were. UnitedHealthcare's New Medtronic Policy Here's what you should know: This only applies to traditional insulin pumps -- from Animas, Roche and Tandem. It does not apply to Insulet's OmniPod, as the insurer doesn't consider the patch pump part of the standard DME (durable medical equipment) category. Supplies for existing in-warranty pumps won't be affected, meaning if you're using an Animas, Roche or Tandem pump, you can still get the needed supplies as long as your pump is still under warranty and not malfunctioning. This new rule does not apply to patients 18 and under (likely due to Medtronic not having pediatric approval for its latest 530G pump-CGM combo). This change doesn't apply to UHC Sierra Health, Life Commercial, or Medicare Advantage plans. Exceptions may be made. The policy states that patients may still be granted coverage for non-MedT pumps on a case-by-case basis, determined by a TBD set of clinical indications that we've yet to see outlined anywhere. I Continue reading >>

Colton Needs Our Help

Colton Needs Our Help

Update: As of 5/26/17, United Healthcare has overturned their denial, and Coltons Omnipod will be covered under the Porter Familys policy. Thank you to the thousands of people who helped raise awareness for Colton! Editors Note: Read this Dads plea to United Healthcare requesting coverage for his autistic, T1D 2-year-old to have the insulin pump he needs (and has been prescribed). Then help by speaking up on behalf of Colton and his family. Lets make some noise! I am a Dad to a wonderful 2-year-old boy that was diagnosed with Type 1 diabetes four days before his 2nd birthday last year. After several days in the hospital we were able to go home and learn how to care for a toddler with Type 1 diabetes. I would be doing him an injustice if I failed to mention that a few months later he was diagnosed with autism. Just whenI thought I was obtaining a novice understanding of Type 1 management,we began working on speech and communication skills with my son, who is for the most part nonverbal. Coltons endocrinologist and developmental pediatrician recommended, and we were able to obtain, the OmnipodInsulin Pump. Having a pump is critical because, as parents, monitoringa non-verbal childsglucoselevelsis particularly challenging. Moreover, Colton an autistic two year old does not tolerate injections well. A separate blessing (I use this term loosely) of his autism is that he will not tolerate loose clothing, strings, blankets, jackets or any other lose hanging thingsthattouch him. And that common reality of autism makes Omnipod, a tubeless Insulin Pump, a critical part of Coltons care. We have already paid for thepump and have been successful in treating with Omnipod. Colton is doing well. And now United Healthcare is putting his healthat risk. The Omnipod, specifically, was pre Continue reading >>

Unitedhealthcare Faq's | Omnipod Insulin Management System

Unitedhealthcare Faq's | Omnipod Insulin Management System

GOOD NEWS FOR UNITEDHEALTHCARE PLAN PARTICIPANTS! Insulet and UnitedHealthcare have established a new network relationship, giving individuals enrolled in UnitedHealthcare commercial and Medicaid* plans in-network coverage for the OmnipodInsulin Management System. Through this new relationship, we are working together to help people access the insulin management technology they need to effectively manage their diabetes. What UnitedHealthcare plans does this apply to? People enrolled in UnitedHealthcares individual, employer-sponsored and Medicaid* plans have in-network coverage for the OmnipodSystem. What does this agreement mean for UnitedHealthcare members? By establishing a direct contract with UnitedHealthcare as an in-network provider, this agreement increases access to the OmnipodSystem for UnitedHealthcare members with diabetes. Did UnitedHealthcare members not have access to the OmnipodSystem prior to this agreement? UnitedHealthcare members have had access to the OmnipodSystem but it was through a third-party supplier. Insulet has worked directly with UnitedHealthcare to reach agreement on a competitive in-network agreement that will give more people the opportunity to enjoy the benefits of the OmnipodSystem. Who should members contact with additional questions? Our highly knowledgeable Customer Care team is here to assist you with any questions. Please call us at 800-591-3455 , Option 4. * Medicaid coverage varies by each states coverage guidelines. Please refer to your benefits plan documents to confirm Medicaid coverage in your state. Access to technology that best suits an individuals needs is paramount for people living with diabetes and is a key priority for our organization. Our mission is to provide our customers simplicity, freedom and healthier lives Continue reading >>

United's Deal With Medtronic Angers Diabetics Over Insurance

United's Deal With Medtronic Angers Diabetics Over Insurance

Patients with Type 1 diabetes are balking at a new UnitedHealthcare policy that steers them to insulin pumps from just one manufacturer. The policy wrongly limits choice, they say, by making devices from Medtronic the “preferred” insulin pump in many health plans sold by the nation’s largest health insurer. “To take away the choice of what is essentially an organ — a body part — it’s insane,” said Jessica Hoffer, a 28-year-old UnitedHealthcare subscriber in Pennsylvania who says she’s used a non-Medtronic pump for eight years. The Minnetonka-based insurer says it’s instituting the policy for patient safety reasons, since pumps from Dublin-based Medtronic have a feature that can help prevent complications from low blood sugar. Choice will remain when doctors show that an exception is warranted for medical reasons, United says. Steering patients to particular medical devices is new, but United says it’s like what the insurer already does with incentives for patients to use certain medications or hospitals. “We’ve got a device here that’s protective, and that capability is unique in the industry,” said Dr. Richard Migliori, the chief medical officer at UnitedHealth Group, the insurer’s parent company. The arrangement is a novel collaboration between two of Minnesota’s biggest names in health care, since Medtronic’s operational headquarters is in Fridley. It could be the first of many such arrangements, as health insurers try to control costs and maintain quality, said Ana Gupte, an analyst who follows managed care companies with Leerink Partners LLC. “If they can steer to one particular manufacturer, the steerage probably gets them a better discount,” Gupte said. “There are probably some system synergies as well. … They may get m Continue reading >>

Expenses Not Covered Under All Uhc Plans

Expenses Not Covered Under All Uhc Plans

Drugs or medicines lawfully obtainable without a prescription, except for covered OTC preventive care medications and supplements or OTC contraceptives Injectable medication and chemotherapy agents administered by a physician or healthcare professional; these medications are generally covered under the medical plan (injectable medications that are commonly self-administered, like insulin, are covered under the prescription plan.) Over-the-counter smoking cessation products and smoking cessation medications not prescribed by a physician, or for dependents under age 18, or filled at a non-network pharmacy Any drug considered to be experimental or investigational by the Food and Drug Administration (FDA) or medications used for experimental indications and/or dosage regimens considered to be experimental Durable medical equipment and prescribed and non-prescribed outpatient supplies other than disposable insulin syringes, insulin pen injectors, needles, insulin pump syringes/ needles, lancets and test strips prescribed with injectable insulin (see the Medical Plan section for durable medical equipment coverage). Immunization agents, biological sera, allergens, allergenic extracts (oral or injectable) and blood or blood plasma (These medications are generally covered under the medical plan.) Any medication administered and entirely consumed in connection with direct patient care rendered in the home by licensed healthcare professionals (These medications are generally covered under the medical plan.) More than a 31-day supply of a covered drug from a retail pharmacy, or more than a 90-day supply of a covered drug from the home delivery program Any medication consumed or administered at the place where the prescription is written, including medication taken or administered Continue reading >>

Unitedhealthcare - Pharmacy - Prescription Drug List

Unitedhealthcare - Pharmacy - Prescription Drug List

Both the Traditional PDL and Advantage PDL are developed through an evidence-based evaluation process that enables us to place the highest value medications in lower copay tiers and align an individuals cost share with the relative value of the medication. On the Traditional PDL, medications may move to a higher tier once per calendar year (January 1). On the Advantage PDL, medications may move to a higher tier up to six times per calendar year. Anytime a brand name medication becomes available as a generic, the tier status of the brand name medication will be evaluated. On the Traditional PDL, generics are automatically placed in Tier 1. On the Advantage PDL, generics are placed in whatever tier is appropriate based on the medications overall value. When a medication changes tiers, you may be required to pay more or less for that medication. These changes may occur without prior notice to you. The benefit plan documents provided by your employer or health plan include a Summary Plan Description (SPD) or a Certificate of Coverage (COC). Please refer to these documents to determine which medications are covered under your individual plan. For the most current information on your pharmacy coverage, please call the Customer Care number on your ID card or go to the Online Pharmacy . Continue reading >>

Unitedhealthcare-medtronic Insulin-pump Deal Prompts Outrage

Unitedhealthcare-medtronic Insulin-pump Deal Prompts Outrage

UnitedHealthcare-Medtronic Insulin-Pump Deal Prompts Outrage A major US health insurance company has announced it is going to restrict coverage for diabetes patients to just one insulin pump brand, which has prompted anger and concern from the patient and professional diabetes communities. Earlier this month, UnitedHealthcare indicated that, on page 7 of a bulletin issued to healthcare providers, starting July 1, Medtronic would become the insurer's "preferred" durable medical equipment provider of insulin pumps for diabetes . Patients won't be required to switch pump manufacturers right away, only after their current pumps go off warranty and no longer function properly. The decision doesn't apply to children under age 18, to continuous glucose monitors (CGMs), or to "disposable" pumps, including Insulet's Omnipod. The policy also doesn't apply to Medicare Advantage members or UnitedHealthcare Sierra Health and Life Commercial members. UnitedHealthcare spokeswoman Kristen A Hellmer told Medscape Medical News, "Patient safety, service, and cost were key considerations in our decision process to partner with Medtronic, as we make a widely used and effective product available to our members while pursuing new ways to lower the cost of living with diabetes." She cited the 2012 ASPIRE study, which found that pumps with a low-glucose threshold-suspend feature currently available only from Medtronic can help reduce the frequency and duration of hypoglycemic events (Diabetes Technol Ther. 2012;14: 205-209 ). Insulin pumps all work essentially the same way, but the brands differ in a variety of features, including insulin reservoir volume and delivery options, waterproofing, screen size and contrast, linkage with glucose meters/continuous sensors, download characteristics, and Continue reading >>

Myuhc.com

Myuhc.com

We want to assist you in maximizing your pharmacy benefit and lowering your overall pharmacy costs. We provide access to a wide variety of U.S. Food and Drug Administration (FDA) approved prescription medications. Our pharmacy network includes more than 66,000 retail pharmacies and OptumRx Mail Service Pharmacy. Just log in to myuhc.com and use our "Pharmacy Locator" tool to find a network pharmacy. Our programs and tools are designed to empower you to make better decisions, live healthier lives and save money on prescription medications. Prescription medication prices are among the fastest growing costs in health care. Our programs and tools are designed to help you make informed decisions about your prescription medication choices and pharmacy product options. At UnitedHealthcare, we want to help you manage your prescription medication costs and get the most out of your pharmacy benefit. One tool you should be familiar with that can help you save money is the Prescription Drug List (PDL).* The PDL* includes the most commonly used medications and groups them on tiers, representing the cost you pay. This cost is decided by your employer or health plan. Tiering medications makes it easy for you to find other options that will help you save money if the drug you are taking is on a higher tier. It's more than a list of drugs, and can help you manage your costs and find other medication options. *The UnitedHealthcare SignatureValue HMO has a formulary, rather than a PDL. IMPORTANT - The above UnitedHealthcare standard PDLs and SignatureValue HMO Formulary do not apply to all plans. If you are a member, log in to myuhc.com to learn about your specific benefit coverage. Health Care Reform - Preventive Care Medications As part of Health Care Reform, health plans must cover ce Continue reading >>

Unitedhealthcare Drops Tandems Insulin Pumps From Choices For Patients

Unitedhealthcare Drops Tandems Insulin Pumps From Choices For Patients

UnitedHealthcare Drops Tandems Insulin Pumps From Choices for Patients Tandem Diabetes Care , Inc. (NASDAQ: TNDM), a medical device company and manufacturer of the t:slim, t:slim G4 and t:flex Insulin Pumps, announced that UnitedHealthcare has made some important andunforeseen changesaffectingmembers of the UnitedHealthcare Community and Commercial Plans, potentially taking away theyre choice in insulin pump equipment provider. UnitedHealthcare Community Plan and Commercial members will no longer have in-network choice among insulin pump providers effective July 1, 2016. UnitedHealthcare has chosen Medtronic as their preferred and in-network durable medical equipment provider of insulin pumps. Tandem Diabetes Care told BusinessWire in a forward-looking statement that a majority of UnitedHealthcare members will not be able to purchase an insulin pump in-network from them and other durable medical equipment providers. Kim Blickenstaff, the president and CEO of Tandem Diabetes Care commented: Having diabetes isnt a choice. How people manage it should be, and that Insulin pumps are not a one-size fits all solution. Selecting which pump is the best fit for a person to manage their therapy needs should be a decision made between a person and their healthcare provider. A media spokesperson for Tandem Diabetes Care wrote, We strongly disagree with UHCs decision, as it limits choice that is so important in individual diabetes care. and that As far as we are aware, there is no medical reason for United Healthcares decision. The spokespersonexplained that regarding pump supplies, UnitedHealthcare will continue to cover Tandem insulin pump supplies until the pump is out of warranty. After that, UnitedHealthcare will require patients to transition to a Medtronic pump if they wish t Continue reading >>

Unitedhealthcare Chooses Medtronic As Preferred Insulin Pump Provider, Starting July 1

Unitedhealthcare Chooses Medtronic As Preferred Insulin Pump Provider, Starting July 1

By Adam Brown and Kelly Close Insurance company UnitedHealthcare has chosen Medtronic as its preferred insulin pump supplier, starting July 1, 2016. Once the policy goes into effect, adults (18+ years) with United insurance will only be covered for a new Medtronic pump – eliminating patients’ ability to get a Tandem, Animas, or Roche pump. (As we understand it, Insulet is excluded from this decision.) The policy does not apply to children 18 years and younger, or to United Sierra Health, Life Commercial, and Medicare Advantage plans. Read the full details here (page 7). If you are currently on a non-Medtronic pump and have United insurance, this news has no immediate impact. Your pump supplies will be covered as long as your pump is under its four-year warranty and still functioning properly. Once your pump goes out of warranty and/or breaks, however, you will be required to switch to a Medtronic pump. If you currently have United insurance and plan to switch to a non-Medtronic pump soon, you will need to: (i) change to a new pump before July 1; (ii) change insurance companies; or (iii) work with your provider to convince United that a non-Medtronic is best for you (generally, this means filing an “appeal”). If you currently have United insurance and do use a Medtronic pump, or you plan to get on a new Medtronic pump soon, this news might bring faster paperwork processing, less administrative hassle, and potentially lower co-pays (United has not confirmed this). To be the only pump offered by United, Medtronic presumably offered a meaningful price discount. In this case, we’re not sure if any of those savings will be passed on to patients (all plans are different, but we haven’t been able to learn anything from United). Exclusive agreements are very common i Continue reading >>

How The Medtronic-uhc Controversy Is Being Spun

How The Medtronic-uhc Controversy Is Being Spun

How the Medtronic-UHC Controversy is Being Spun We read the tea leaves of statements, or lack thereof, of United Healthcare, JDRF, Medtronic, and Tandem. As you probably have heard by now, UnitedHealthcare recently made a veeery unpopular decision with the diabetes community by choosing Medtronic as its preferred supplier of insulin pumps. Reactions came swift and furiously on the diabetes blogosphere , and there have been several coordinated efforts to protest this move. To see how this plays out, it might be helpful to see how the principle players reacted publicly in the initial days of this controversy. First, lets examine how UnitedHealthcare rolled out this decision. The policy shift was given a brief mention in a thick 31-page brochure: As part of our ongoing efforts to provide a better member experience, while increasing quality and lowering the overall cost of diabetes care in the United States, UnitedHealthcare has reached an agreement with Medtronic to become thepreferred, in-network durable medical equipment (DME) provider of insulin pumps for UnitedHealthcare Community Plan and Commercial members, effective July 1, 2016. Our goal is to provide the opportunity for a better care experience by providing our members with access to advanced diabetes technology and comprehensive supportservices while learning how advanced technology can be applied to improve outcomes and reduce costs. We also aspire to find new ways to analyze the total cost of carefor diabetes management, bring a value-based approach to diabetes care for UnitedHealthcare members and place greater focus on quality rather than the volume of care delivered. Standard corporate argle-bargle. UnitedHealthcare is a huge insurance provider, and this is not their first rodeo when it comes to announcing Continue reading >>

I Want United Healthcare To Cover My Son's Diabetic Pump Supplies

I Want United Healthcare To Cover My Son's Diabetic Pump Supplies

My 14-year old son Ben has had diabetes since age 3. We've used three different insulin pumps over the past 10 years. In 2016, we changed to an Omnipod system, which has no plastic tubing (a big issue for an adolescent). United HealthCare has been covering pump supplies for the Omnipod system since 2016. Since January, we've been repeatedly denied coverage for his pump supplies with no explanation -- and plenty of phone calls, misinformation, and dead ends. Our wonderful endocriniologist spoke to a doctor at United HealthCare who told us that the United HealthCare doctor "claims that UHC in generally trying to "steer away" (his words) from Omnipod and that Medtronic is their preferred pump provider." According to United HealthCare's website: "Children 18 and younger are not part of the preferred agreement with Medtronic and can continue using a non-Medtronic pump." Please help us convince United HealthCare that children living with type 1 diabetes should be able to choose the insulin delivery system that best matching their lifestyle and preferences, and that brokering deals with DME companies may be great for shareholders, but are not in the best interest of patients. Continue reading >>

Unitedhealthcare's Medtronic Deal Sparks Furor, But A Year Later, Innovation Continues

Unitedhealthcare's Medtronic Deal Sparks Furor, But A Year Later, Innovation Continues

UnitedHealthcare has not released numbers on how many patients are affected by its exclusivity deal with Medtronic. While the initial press stories criticizing the transaction have died down, a JDRF initiative calls on insurers to preserve patient choice. When UnitedHealthcare (UHC) announced in May 2016 that it would only cover insulin pumps made by Medtronic for most adults, patient advocates decried the news as both a major loss for those affected and, quite possibly, a harbinger of a world where exclusivity pacts stifled competitive innovation. Investors, it seemed, were in full agreement. Shares of smaller pump maker Tandem Diabetes Care immediately dropped 20% when news of the deal became public.1 Such predictions, however, may prove overly dramatic. The past 16 months have seen Medtronic sign an outcomes-based payment agreement with another insurer, but no insurer has followed UHC’s lead and signed exclusivity pacts with Medtronic or any other pump maker. If UHC patients are protesting the policy, they have been less visible in recent months. The exclusivity deal helped inspire a campaign by JDRF (formerly the Juvenile Diabetes Research Foundation),2 but the early media coverage has waned. As for the deal’s impact on UHC patients, outsiders are forced to guess. UHC has declined to disclose any figures related to the policy: how many of its policyholders use insulin pumps, what pumps they chose before the transition, or how many have switched to Medtronic after preferred pumps broke or were out of warranty. An estimated 1.25 million3 (0.4%) of the nation’s 325 million people4 have type 1 diabetes (T1D). Estimates of the percentage of American patients with T1D who use a pump vary, but the JDRF currently reports the figure at 40%.5 Roughly 75% of all pump use Continue reading >>

Insurers Heavily Restrict Diabetes Coverage In 2017

Insurers Heavily Restrict Diabetes Coverage In 2017

Dear Betics, ​ Nothing makes me madder than having to arduously fight the insurance bureaucracy to stay alive. And the NPR report I read today has my heart racing with indignant rage on behalf of diabetics everywhere who KNOW what a struggle it is to cry, beg and plead with the insurance company in an effort to coerce them into doing the very thing they’re charged with doing: keeping you alive and well. If you have diabetes, you probably (like me) burst into tears at least three times per year after ending a call with a customer service representative who insists your life-saving diabetes treatment isn’t covered by insurance. Before you continue reading, get your game face on, because this is going to piss you off. In 2017, diabetics who get their meds through CVS Caremark or Express Scripts are in for some blood boiling adjustments to diabetes (and other) drug coverage. NPR’s got the full story, and you can read it here. For my part, I’ll summarize the CVS diabetes drug denial list for 2017 (because it’s bigger than the Express Scripts list), and discuss why denying people the drugs they need to stay alive is so awful. Both companies are choosing to remove brand name drugs from their formulary and instead are choosing to cover generic versions. Fine. We’re all accustomed to that. That isn’t news. Substituting generic for brand name happens ALL the time. I’m not upset about that. Here’s what I AM upset about: the prescription insurers are choosing to replace some of your current meds with biosimilar medications (this happens from time to time with all insurers, but not to this degree). Replacing a drug with a biosimilar is NOT the same thing as replacing a brand name drug with a generic drug that has the exact same ingredients. In this particular con Continue reading >>

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