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Evidence-Based Diabetes Management September 2017

UnitedHealthcare's Medtronic Deal Sparks Furor, but a Year Later, Innovation Continues

Andrew Smith
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.
Such a situation would not be historically unique. The number of pump makers has waxed and waned considerably over the past 40 years. New entrants have kept coming in with new technology, trying to dethrone MiniMed, the dominant player purchased by Medtronic for $3.7 billion in 2001.21 None have succeeded, but their efforts have helped fuel a steady improvement in pump technology. Pumps have gotten considerably smaller, more discrete, smarter, easier to use, and more reliable since they first appeared in the 1970s.22   There is reason to believe that more players will enter the market with new ideas. For example, Bigfoot Biomedical is performing clinical trials on a system that includes a pump that has no controls on its body because it is controlled through a smart phone app.23 

Even if fewer new companies enter the market and the pace of traditional pump development slows, patients will see differences. Today’s models are good enough that observers like Close see little need for dramatic hardware improvement, regardless of how competitive the pump market is. Mechanical improvement will continue, she thinks, but more of the value will come from the brains of the pump.

“Insulin is an incredibly dangerous drug, and a machine will always figure out dosing better than patients or parents or partners. Automation is where we’re going, and it’s all about the algorithms and who can make the easiest-to-use systems—take away steps, make things easier to use and smarter. That could come from the largest pump manufacturer, but it doesn’t necessarily have to. It can come from another company or academic or even hobbyist who wants to write it,” said Close, who gave the interview while testing a system that used software written by 1 individual to control her insulin.

“I can’t wait to try the 670G, and I can’t wait until it’s widely available. For now, having a smart algorithm in a box that costs $126 and keeps me between 80 and 120 all night every night is pretty excellent. Medtronic raised the bar with its new pump and the outcomes that they have proven (mainly less hypoglcyemia)—and they shouldn’t, and won’t, take their eye off the ball because the field will keep raising the bar ever higher.”

References
 
1. Lawrence S. Tandem off 20% as it loses insurer to Medtronic for insulin pumps. Fierce Biotech website. http://www.fiercebiotech.com/medical-devices/tandemoff-20-as-it-loses-insurer-to-medtronic-for-insulin-pumps. Published May 3, 2016. Accessed August 20, 2017.
 
2. JDRF launches “Coverage2Control,” a campaign to urge insurance companies to provide coverage that works for the type 1 diabetes community [press release]. New York, NY: JDRF; May 23, 2017. http://www.jdrf.org/press-releases/jdrf-launches-coverage2control-campaign-urge-insurance-companies-provide-coverage-works-type-1-diabetes-community/. Accessed August 201, 2017.
 
3. Type 1 diabetes facts. JDRF website. http://www.jdrf.org/about/fact-sheets/type-1-diabetes-facts/. Accessed August 20, 2017.
 
4. US Census Bureau. US and world population clock. https://www.census.gov/popclock/. Accessed August 29, 2017.
 
5. UK still trails Europe and the USA on providing insulin pumps for type 1 diabetes. JDRF website. https://jdrf.org.uk/news/uk-still-trails-europe-usa-providing-insulinpumps-type-1-diabetes/. Published April 5, 2016. Accessed August 20, 2016.
 
6. Idlebrook C. A look into Medtronic’s game plan. Insulin Nation website. http://insulinnation.com/treatment/a-look-into-medtronics-pump-game-plan/. Published August 19, 2016. Updated August 22, 2016. Accessed August 20, 2017.
 
7. UnitedHealthcare. Network Bulletin, May 2016. UHC website. https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-S/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/News/May-Network-Bulletin_PCA-1-001514-04052016_R5.pdf. Published May 1, 2016. Accessed August 28, 2017.
 
8. UnitedHealth Group website. Webcast replay: medical members, 2016. UHC Group website. http://www.unitedhealthgroup.com/Investors.aspx#close. Published
August 22, 2017. Accessed August 28, 2017.
 
9. Scheiner GS. Is an insulin pump really a commodity? Integrated Diabetes Services website. http://integrateddiabetes.com/united-healthcare-decision-to-limit-coverage-
for-insulin-pumps-to-medtronic/. Published May 20, 2016. Accessed August 20, 2017.
 
10. FDA approves first automated insulin delivery device for type 1 diabetes [press release]. Silver Spring, MD: FDA; September 28, 2016. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm522974.htm. Accessed August 28, 2017.
 
11. Bergenstal RM, Garg S, Weinzimer SA et al. Safety of a hybrid closed-loop insulin delivery system in patients with type 1 diabetes. JAMA. 2016;316(13):1407-1408.
doi:10.1001/jama.2016.11708.
 
12. Hooman H. Medtronic announces new outcomes-based agreement with Aetna. Medtronic website. https://www.medtronicdiabetes.com/blog/medtronic-announces-new-outcomes-based-agreement-aetna/. Published June 26, 2017. Accessed August 20, 2017.
 
13. Berkrot B. Medtronic deal with Aetna ties insulin pump payment to patient results. Reuters website. http://www.reuters.com/article/us-medtronic-aetna-diabetes-idUSKBN19H1GB. Published June 26, 2017. Accessed 20, 2017.
 
13. Medtronic announces outcomes-based agreement with Aetna for type 1 and type 2 diabetes patients [press release]. Dublin, Ireland: Medtronic; June 26, 2017. http://newsroom.medtronic.com/phoenix.zhtml?c=251324&p=RssLanding&-cat=news&id=2283068. Accessed August 20, 2017.
 
14. Tandem Diabetes Care reports first quarter 2017 financial results [press release]. San Diego, CA: Business Wire; April 27, 2017. http://investor.tandemdiabetes.com/
releasedetail.cfm?releaseid=1023362. Accessed August 20, 2017.
 
15. Tandem Diabetes Care reports 2016 financial results [press release]. San Diego, CA: Business Wire; March 8, 2017. http://investor.tandemdiabetes.com/releasedetail.
cfm?releaseid=1016615. Accessed August 20. 2017.
 
16. Hopkins JS. J&J forecast disappoints as drugmaker mulls diabetes unit sale. Bloomberg Markets website. https://www.bloomberg.com/news/articles/2017-01-24/johnson-johnson-tops-analysts-estimates-on-strong-drug-sales. Published January 24, 2017. Accessed August 20, 2017.
 
17. OneTouch Vibe pump earns FDA approval and Health Canada license and is first pump integrated with the Dexcom G5 mobile continuous glucose monitor [press release].
Chesterbrook, PA: PR Newswire; December 20, 2016. http://www.prnewswire.com/news-releases/onetouch-vibe-plus-insulin-pump-earns-fda-approval-andhealth-
canada-license-and-is-first-pump-integrated-with-the-dexcom-g5-mobilecontinuous-glucose-monitor-300381728.html. Accessed August 20, 2017.
 
18. Caffrey M. GAO reviews Medicare’s approach to covering medical equipment, including insulin pumps. The American Journal of Managed Care® website. http://www.ajmc.com/focus-of-the-week/0717/gao-review-medicares-approach-to-covering-medical-equipment-including-insulin-pumps. Published July 18, 2017. Accessed August 28, 2017.
 
19. Hoskins M. Roche hands off remaining pump customers to Medtronic. Healthline website. http://www.healthline.com/diabetesmine/roche-hands-off-remainingpump-
customers-medtronic. Published August 14, 2017. Accessed August 20, 2017.
 
20. Robinson-Jacobs K. Medtronic to buy MiniMed and affiliate. Los Angeles Times website. http://articles.latimes.com/2001/may/31/business/fi-4587. Published May 31, 2001. Accessed August 28, 2017.
 
21. McAdams BH, Rizvi AA. An overview of insulin pumps and glucose sensors for the generalist. J Clin Med. 2016;5(1):5. doi:10.3390/jcm5010005.
 
22. Bigfoot Biomedical enrolls first patients in clinical trial of smartloop automated insulin delivery system [press release]. Milpitas, CA: Bigfoot Biomedical; July 21, 2016.
https://www.bigfootbiomedical.com/first-clinical-trial/. Accessed August 20, 2017.
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