Value-based agreements between insurers and drugmakers have gotten a lot of attention lately, but device makers, including those that make continuous glucose monitors, are also making deals with insurers that tie payment to how the device performs.
Suzanne Winter, vice president of the Americas region for Medtronic, says a value-based agreement with Aetna focuses on demonstrating improvements in HbA1c levels for patients who transition to a Medtronic insulin pump from multiple daily insulin injections. If improvements are not demonstrated on an aggregated basis, Medtronic will pay Aetna a rebate.
Continuous glucose monitors are linked with insulin pumps to create so-called “artificial pancreases.”
In an agreement with UnitedHealthcare, Medtronic has established a value-based partnership in which both companies will evaluate the cost of care of patients who are treated with Medtronic’s insulin pumps that have glucose monitors included and compare it with the cost of care of those treated with insulin injections. Children and adolescents and Medicare Advantage members are not part of the arrangement. The partnership also established Medtronic as the exclusive in-network supplier of insulin pumps for UnitedHealthcare members with diabetes.
“Patient safety, service, and cost were key considerations in our decision to work with Medtronic,” according to a spokesperson for UnitedHealthcare.
The deal is controversial.
“As a physician, I can see why they may prefer the Medtronic pump over other devices, but you’re removing choice from the doctor–patient relationship. I just don’t think that that’s fair,” says Joshua Miller, MD, medical director of diabetes care for Stony Brook Medicine, the health care system that includes Stony Brook University Hospital in Long Island. Miller was diagnosed with type 1 diabetes as a teenager and uses an insulin pump and glucose monitor. He declines to identify the brands.
“Putting on my patient hat, it frustrates me to think about preferred devices from the payers because it limits patient choice,” says Miller. “As a patient, I should be able to discuss with my endocrinologist whichever pump or sensor I’d like to use, regardless of manufacturer.”
Cynthia Rice, a JDRF senior vice president, says her organization has criticized the UnitedHealthcare deal as a central part of its Coverage2Control campaign, which supports insurance coverage of “artificial pancreas” systems in general.
“We thought UnitedHealthcare had made the wrong choice. The core part of our campaign was to try to prevent the other health plans from following UnitedHealthcare on this matter. The good news is that of the 25 largest plans in the nation, only United has this policy,” she says.
The campaign calls for “pump choice,” she says, “to make sure people have access to that type of insulin pump that works best for them because different insulin pumps have different features that are relevant for different people.” Rice is encouraged that UnitedHealthcare and another pump manufacturer, Insulet, came to an agreement in March so that UnitedHealthcare customers can be prescribed either the Insulet or the Medtronic pump: “We’re making progress,” says Rice.
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