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JDRF Announces Anthem Policy Change on Medtronic Artificial Pancreas

Mary Caffrey
The Coverage2Control campaign has worked to convince payers of the value of life-saving technology and the need to control out-of-pocket costs.
Anthem has changed its coverage policies to include the Medtronic MiniMed 670G, the first device to meet FDA’s definition of “artificial pancreas.” JDRF announced the policy change as a victory for its Coverage2Control campaign, which has advocated with payers to ensure choice in diabetes technology for people living with diabetes.

Specifically, the Anthem update says the payer will cover the MiniMed 530G, the 630G, and the 670G. The document does not specifically address supplies related to the devices. Anthem will cover the devices only for patients with type 1 diabetes (T1D) who are age 7 or older and who have a glycated hemoglobin (A1C) value of 5.8% to 10% and for whom the device is “medically necessary.”

“This is a great victory for the T1D community. By taking a tremendous step, Anthem is giving its members with diabetes access to this breakthrough in diabetes management,” said JDRF president and CEO Derek Rapp in an e-mail to The American Journal of Managed Care®.

“I am so proud of how the Coverage2Control campaign helped make this happen. We applaud Anthem for this decision, and will continue to push insurers to make changes to coverage that enable better diabetes management.”

Launched last spring, the JDRF campaign has 3 elements: (1) it asks health insurers to keep out-of-pocket costs for insulin, technology, and supplies “predictable and reasonable,” (2) it calls on insurers to give people the “freedom to choose the insulin pump that’s right for them,” and (3) it asks insurers to cover “all life-saving technology.”

That last element became a focal point after leading insurers declined to cover the Medtronic 670G shortly after FDA approval, dimming the enthusiasm of the T1D community that had waited years for this breakthrough. It raised fears that the same fate would await competing products in the pipeline, including those from smaller companies that might lack Medtronic’s ability to ride out a protracted battle with payers.

Diabetes advocates feel strongly that having competition in the technology sector matters, both to promote innovation and to give patients choices. An exclusivity agreement between Medtronic and UnitedHealthcare was cited as a contributing factor in Animas’ decision to leave the pump market earlier this year. Animas was part of Johnson & Johnson Diabetes.

Anthem is one of the nation’s larger payers with 40 million members; the statement did not specify how many have T1D. The American Diabetes Association and CDC have put the T1D population in the United States at about 1.25 million, a fraction of the overall diabetes population of 30.3 million.

JDRF said it has reached agreements for all 3 parts of its Coverage2Control program with Aetna, Health Care Service Corp, Humana, Kaiser Permanente, Medica, and Blue Cross Blue Shield plans in Alabama, Florida, Massachusetts, Minnesota, North Carolina, and Tennessee.

The much larger type 2 diabetes (T2D) population will not have access to this technology through Anthem, but experts predict that at last a component of the “artificial pancreas,” continuous glucose monitoring (CGM), will gain popularity among T2D patients as the sensors become smaller and less expensive and can interact directly with cell phones instead of requiring a separate transmitter.

Earlier this year, Medicare approved the Dexcom G5 CGM for T1D and certain T2D patients on intensive insulin therapy, which was a major policy shift.

 
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