Tag Archives: United Healthcare

Are you okay with this?

Monday, United Healthcare and Medtronic went one step further on their “preferred agreement” to make the Medtronic 670g the lone insulin pump choice they will approve of without a fight.

Since the U.S. Food and Drug Administration has now approved the 670g for use with patients age 7 and older, now it’s the only one you can get for anyone 7 or older unless you work with your doctor to submit forms and do things that, under other plans, you wouldn’t have to do to get a new pump.

I wish I could say it in a nicer way. I have friends working at Medtronic, and friends insured by UHC.

I don’t know antitrust law. But… the largest insurer in America linking up with the largest insulin pump maker in America to effectively shut out all other insulin pump and continuous glucose monitor competition? Is anyone, at either UHC or Medtronic, benefiting from this agreement? In what way? How much?

Everyone I’ve spoken to who has used the 670g likes it. I’ve rarely heard anything negative. But shouldn’t patients be allowed to choose what they want to wear every day anyway? If they are allowed, pending certain requirements being met, to choose a different option, why should there be an agreement in the first place?

United Healthcare is fond of saying that over 90 percent of their patients with diabetes who choose insulin pumps already choose Medtronic. That’s disingenuous, because they’re effectively forcing patients to choose the 670g anyway.

Meanwhile, Medtronic has a goal of dominating the market. Until these United Healthcare agreements came into play, I believed it was because they were convinced they had a best-in-class product.

If you believe you have a best-in-class product, why work so hard to squeeze off opportunity for your competitors? It’s clear to see the detrimental effect this will have to Tandem and Dexcom, as well as any new entities working on closed loop solutions here in the USA and around the world.

There is more money to be made on pumps and CGMs in the United States than anywhere else. Medtronic seems to be doing its best to get the most of that market for themselves. Not through competition, but rather by stifling it.

United Healthcare is getting its own benefits from whatever it gets from Medtronic, the ability to streamline paperwork and approvals for 90 percent of pump and CGM patients, and the framework for similar agreements affecting patients living with other conditions.

Do you feel like this is unfair? Do you feel People With Diabetes should be able to freely choose to use any device that works best for them?
Send your e-mail to United Healthcare telling them this is wrong
Thanks to JDRF and their #Coverage2Control initiative for the link.

If you’re a person living with diabetes, or a person caring for someone living with diabetes, there is absolutely no good reason for a decision like this to be allowed to go forward without a fight.

It’s up to us.

So a lot of people received letters like these in the mail recently:
I’m not sure the letter has a purpose, other than to prove that the writer, Dr. Richard Migliori, Chief Medical Officer at UnitedHealth Group, can write an entire page full of words and still not say anything meaningful. I suspect that in this case, that was the point. Plus, in all fairness, it’s hard to be both a doctor and an administrator at the same time.

Now, you might think this letter would make me mad, because it doesn’t really address my concerns at all. But I view it positively. Despite the archaic nature of the correspondence, it is actually communication. From a real person.

Here’s the thing: As a result of the various #DiabetesAccessMatters campaigns, people know we exist now. And they feel like they need to respond to us. Look… UHC wasn’t going to get a bunch of letters and then immediately wake up and say, “Whoa, maybe we’re not doing the right thing here. Maybe we should change our minds”. But in raising our voices, we began a dialogue. It’s a dialogue that will probably have to continue for some time, but that’s my point.

Now that the dialogue has been opened, we need to keep the conversation going. Maybe that means responding to a letter like this directly. Maybe that means calling your state’s insurance commissioner to voice your concern. Maybe that means letting your employer know that UHC isn’t your favorite insurer right now. That’s what I did, and I think my state insurance commissioner is next.

Much of the answer to the #DiabetesAccessMatters issue is the same as it is for other issues before us as People With Diabetes or friends or family of PWDs. To win the day, we must apply pressure, and keep the pressure on. We need to overcome fear by standing in the knowledge that we are on the right side of history.

We’re not asking for anything more than what we deserve. UHC patients are not asking for anything less than what they had prior to July 1. Because it’s what they deserve. It’s what they’re paying for. And, oh by the way, it wouldn’t cost UHC one extra dime to allow the same choice that existed less than a month ago.

So don’t stop communicating. This conversation may be just beginning. It’s up to us to make sure it doesn’t end until choice is restored.

What’s Next?

Like you probably did, I read Kerri Sparling’s blog post about how she’s still unhappy that nothing has happened since the United Healthcare/Medtronic Diabetes dustup. Like her, I can sense the dust settling at this point, and I wonder if anything meaningful will come of all our vitriol just a month ago.

I’ve thought about this from time to time since the announcement was made back in May, and I’ve come to the conclusion that there are some things I know, and some things I don’t know about all of this. While we know the issue, and what’s at stake, we all undoubtedly feel a sense of resignation, that “this is how business works and there’s not much we can do about it”.

Well, that may be true. Maybe there’s nothing we can do about it. I don’t think it’s that simple though. I do know that if we’re going to turn the tide of businesses trying to rule our access to tools designed to help us be as healthy as possible, certain things need to happen. In no certain order, here are just four of those things.


Holes need to be poked in this arrangement. I’ll bet you can state one or two things that are wrong about this business deal right off the top of your head. We need to find more things that are wrong with this, and point them out, over and over again, to anyone who will listen. We need to find out things that are wrong about the businesses and the people running those businesses that are wrong. I’m not advocating personal attacks, of course. But is there a track record here that needs to be noted? Maybe an indicator of what’s to come based on similar tactics these companies/people have employed in the past? And we need to keep hammering those points home. In the current business climate in the USA, these people already know that they can get away with making arrangements that only suit themselves and not patients. We need to make it uncomfortable for them to do so. As uncomfortable as possible, even if it’s one blog post at a time, one insurance claim at a time, one protest at a time, one person standing up and stating what is right. We cannot let injustices go without standing up and pointing them out. Over and over again.

Tweak the message. Why do you think JDRF gets such big dollars for research? Let me ask you another question: do you ever see someone like me in JDRF literature? Of course you don’t. That’s because even though I have the same disease as a cute ten year old, time and again people will react positively to the message that a child doesn’t deserve to live with this, even if I’ve been living with it for at least fifteen years longer.

Okay, I’m a little off topic here, so let me bring it back to the issue at hand. Anger is good… it gets our blood flowing, it’s often the catalyst for developing platforms for change. But if you can’t tell a story, a compelling story, a heart wrenching story about why all patients need access to the best care and drugs and devices, people are going to question why they should care. This is where I’m at a disadvantage. I’m good at telling you what’s happened, but I’m not always good at making it overwhelmingly compelling. But I know I need to do that. We need to turn our outward message of anger into inward concern for actual people. And quickly.

These companies need to be hurt where it counts– in the financials. Sorry to be the one to tell it so bluntly. But let’s face it: by and large, as long as company execs are getting their bonuses, they really don’t care about you or I. This deal falls apart when it no longer makes financial sense, from either a corporate or a personal point of view, for it to continue. I don’t know if that means we find a legal way to keep them in court fighting for their stupid deal (and fund the fight), or if that means we encourage a boycott of United Healthcare and Medtronic for years to come, or if it means that we encourage patients to find ways to make United Healthcare pay more in claims under this agreement (which they would fight). But when the money is no longer there for this deal, there will be no reason for it to continue.

Relentlessness. Do you think The CEO of United Health Group, or the President of Medtronic Diabetes are actually thinking about any of this anymore? They’re not. Of course they’re not. They knew that there would probably be an initial reaction. They knew that the initial reaction would probably die down. Now they’re just going on with their lives like nothing ever happened. You’re just a dollar sign… you’re not a person to them.

I’m not a big believer in the fact that everything needs a coordinated effort to accomplish a big goal. But here’s one instance where a little coordination could come in handy. I’ll give you an example: sit-ins at lunch counters in the south back in the 60s. White authorities were sure that all that was needed was to arrest the African-Americans sitting at the segregated lunch counter, and it would all be over. But as soon as the initial protesters were arrested, new protesters immediately came forward and sat down in their place. Authorities only thought there were a few protesters… they didn’t count on many, showing up over and over again. That’s what we need.

As a community, our initial reaction to all of this was wonderful, and creative, and even inspiring. But now there’s nothing. A coordinated effort that has one person writing about it this week, another meeting with their elected officials the next week, bombarding state insurance commissioners the following week– that’s how we start to chip away at the wall that’s been built between business and patients. Little by little, over and over, never giving up, until we either force an end to this type of practice or make it unsatisfying for companies to engage in this kind of behavior in the first place.


As U.S. citizens, we believe in our original Declaration of Independence and our Constitution, which promote the idea of choice as a basic right for all people. Those documents don’t say anything about the right to squeeze out as much profit as possible, or that doing so at any cost to patients is okay.

I don’t have a great plan, or anything nearing all the answers. But I do know that the one thing we can do, all of us, is continue to assert that our human right to choose is the most important message in this debate. You think this collaboration between UHC and Medtronic fosters innovation? I don’t care if it does… it destroys my right to choose (and it doesn’t foster innovation– quite the opposite). You think it gives patients a best-in-class platform to manage their diabetes? I don’t care… it destroys my right to choose, today and in the future, so if a better product becomes available, I might be unable to choose it. You think having a “clinical exception process” in place for people who want to choose a different option actually proves you’re still allowing choice? You’re wrong… it destroys my right to choose, and it gives other greedy businesses a template for denying choice, and I’m not okay with that.

This attitude needs to be here, on the faces of the Diabetes Community, in every interaction with these entities, until policies like this are a thing of the past. They’re only trying to get everything they can. I’m fighting for what I want too, and what I want is more important. And I am not ashamed to say so. Yesterday, today, and tomorrow.

Choice Is Necessary.

United Healthcare has decided that, as of July 1, adult patients with diabetes on certain UHC insurance plans who want insulin pump therapy should only be allowed to choose a Medtronic insulin pump. Hat tip to DiabetesMine for breaking the news.

There’s a lot more to it than just that one sentence, and obviously, people have a lot of questions.

Let me first say this: people who work for medical device makers and insurance companies are actual people, and they have families and concerns of their own, so I don’t think it’s fair to equate companies and their practices with the people who work hard for them every day.

That said, it’s really hard to find anything good in this discovery. Let’s be honest, okay? There is nothing good in this discovery. It is only benefitting those implementing the rule, and only harming those affected by the rule.

There was some explanation from United Healthcare about why they’re going down this road, and it’s a ridiculously weak argument. You can come to your own conclusions about it after you read what they have to say about it. But my take is that they’re not even trying to give a good explanation for this. Medtronic, for their part, has remained silent.

Did UHC get something for making Medtronic an exclusive provider? Or are they just being lazy, deciding they don’t want to keep up on all of the insulin pump manufacturers out there? Is Medtronic out there trying to cut similar deals with other insurance companies? Does this put pressure on other device makers to try and secure their own piece of the pie? Most of all: What if an actual artificial pancreas solution is approved by the U.S. Food and Drug Administration, and it’s not a Medtronic solution? Does that leave UHC patients out in the cold?

I’m not even going to try to answer those questions. They’re not important. They just don’t matter.

Because any way you slice it, this is bad news for People With Diabetes.

United Health Group, parent company of United Healthcare, has this as their mission statement:
“We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities.”

“We work with health care professionals and other key partners to expand access to quality health care so people get the care they need at an affordable price.”

“We support the physician/patient relationship and empower people with the information, guidance, and tools they need to make personal health choices and decisions.”
It appears that the latest about this exclusivity arrangement shows UHC’s mission statement to be rather disingenuous. In fact, it looks like they just took a giant shit all over it and its claims to “expand access to quality health care so people get the care they need at an affordable price”.

Reducing Eliminating choice for patients is wrong, it reduces innovation, and in no way does it “improve the overall health and well-being” of People With Diabetes, or even save them money.

I’m going to start saying something, and I’m going to repeat it any time someone asks me why something like this is a big deal.

Choice isn’t just important… choice is necessary.

Companies love to talk about how competition is good for the marketplace, good for consumers. Apparently, it’s not good enough for United Healthcare, because they just turned a fire hose on the idea of competition. You know, there are studies that show People With Diabetes do better when they have more information, more tools, and yes, better tools to help them manage their condition. I can’t find a single shred of evidence anywhere that says removing choices for patients with a chronic condition helps them live better lives.

You are wrong, United Healthcare. You’ve made a decision that only benefits you, and does not ensure even one better outcome for any of your patients. You are wrong, and I will keep telling your rotten story to as many people as I can. Including my elected officials, and news agencies.

For my part, I wish I would have had access to this information when I visited Medtronic a couple of weeks ago. The upper echelons of Medtronic Diabetes management was there that day, and someone must have known that this decision was imminent. But they didn’t share it with any of the advocates in the room. I would have liked to have asked questions and share my view directly with Medtronic brass that day.

Just as there are actual people working for these two organizations, there are actual People With Diabetes insured by UHC. And those people deserve and are entitled to choices when it comes to how they manage their diabetes. Patient trumps proprietary. And it always will.

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