Monday, October 30, 2017

Very Brief Blog: Talk on Diabetes Insulin Pumps & Medicare Policy (Intl Diab Tech Mtg, Bethesda, Nov. 2, 2017)

I'm giving a talk on Thursday, November 2, 2017, in Bethesda at the Diabetes Technology Society international annual meeting.   The conference website is here

My presentation is in a series on reimbursement, from continuous glucose meters, to diabetes telemedicine and prevention, to artificial pancreas.   I'm posting the deck I will present, on insulin pump policy: here.

Some key points:

  • Medicare is a defined benefit program, and insulin pumps and their insulin are under the benefit for DME (including wheelchairs, etc). 
  • There's one legacy pump code, E0784, priced at about $5400 regardless of brand or pump capabilities.
  • You have to be doing demonstrably badly enough on insulin before Medicare covers a pump.  
  • Due to 2003 rules, insulin pricing for pump-based insulin had gotten badly out of whack with the current market, only about 30% of market price.  However, it was reset to market price on 1/1/2017.
  • The GAO did a report strongly supportive innovation for new technology in the DME benefit.  CMS's reaction was lukewarm or less.   Here.
  • CMS rejected a special new code for artificial pancreas (e.g. very smart insulin pumps) in 2014, but is reconsidering now, with a decision expected in November 2017.