Managing diabetes is expensive. Of course there are physical and mental costs, but it hits the wallet hard too. For those who require daily insulin, going without needed supplies is not an option. Some insulin devices, such as the OmniPod®, cost as much as $3,000 to $4,000 a month, and for many people, shelling out that much money would be impossible without insurance coverage.
But until recently, devices like the OmniPod® were not expressly covered by the Centers for Medicare & Medicaid Services (CMS). Older devices that delivered insulin through a tube were covered under Medicare Part D, but there was lack of clarity around the newer, more innovative and more convenient devices. According to Senator Susan Collins’s website, patch pumps were not insured under Medicare Part D, which meant that while those using newer devices may have been covered under private insurance, they would lose this essential coverage when they aged into medicare.
Both lawmakers and those trying to afford diabetes management supplies were frustrated that there wasn’t clarification around whether or not newer, less invasive insulin delivery systems would be covered by CMS. 66-year-old Deborah Hall, for example, had been considering postponing her retirement so that she wouldn’t lose coverage for her OmniPod® device. Now that CMS has clarified that OmniPod® and other newer devices should be covered under Part D, her retirement is back on schedule. “It makes all of those future plans really possible for us to look at and to think about. Before we were going, ‘Well, we can’t do that yet,'” Deborah said.
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Senators Susan Collins (R-ME) and Jeanne Shaheen (D-NH) had sent a letter urging CMS to cover more advanced diabetes management technologies such as patch pumps, and they were both delighted when the CMS responded by telling Part D sponsors that they could cover newer insulin delivery systems. “I am thrilled that CMS responded to our advocacy by removing this unnecessary barrier to this lifesaving and cost-effective therapy,” Senator Collins said.
Of course, CMS noted that they would not require Part D sponsors to include the new devices in their covered options, and that sponsors may apply certain criteria, but it is still great news that new devices are eligible for Part D coverage.
The makers of OmniPod®, a device that delivers insulin without the use of tubes or the need for daily injections, are understandably pleased. “…Individuals living with diabetes deserve the right to choose the product that will best help them manage their diabetes,” Patrick Sullivan, the CEO of Insulet Corporation, said. Of course, since Insulet Corporation sells the OmniPod® system, they stand to gain from these new guidelines, but so do people like Deborah Hall. And that is something to be excited about.
We hope this news means that those with insulin-dependent diabetes will have more options as they move into retirement. Thank you to everyone who pushed for these new guidelines, and we hope that barriers facing those with diabets continue to be broken. Stay healthy, friends!