Medicare announces coverage of insulin pumps for beneficiaries
By MATTHEW HAY
HHBR Washington Correspondent
BALTIMORE The Health Care Financing Administration (HCFA; Baltimore) announced last week that it is expanding coverage to insulin infusion pumps for eligible beneficiaries with Type I diabetes. The agency said the decision to re-evaluate the previous policy came after conducting a technological assessment that included an analysis of peer-reviewed medical journal articles, as well as consultations with the American Diabetes Association (Alexandria, VA), the American Association of Clinical Endocrinologists (Washington), manufacturers of insulin pumps, and physicians.
The agency said the expansion marks the first coverage decision made under the agency’s new coverage process that taps medical and scientific evidence, such as medical literature and data, discussions with medical experts, and technology assessment, to make national coverage decisions.
"Based on analysis that used evidence-based research, HCFA decided that Medicare beneficiaries should have access to this new state-of-the-art therapy," said Jeffrey Kang, director of HCFA’s Office of Clinical Standards and Quality.
Under the new coverage policy, Medicare will pay for the pump when prescribed for beneficiaries who have Type I diabetes, otherwise known as juvenile onset diabetes. In Type I diabetes, the pancreas fails to produce insulin. The insulin pump permits users to maintain tight control of glucose by propelling insulin from the pump reservoir through an infusion set into a catheter inserted under the skin of the abdomen or hip.
Type I diabetes is less common than Type II diabetes, which is more prevalent in the Medicare population. Type I diabetes accounts for 5% to 10% of all diabetes patients. Type II, a disorder resulting from the body’s inability to make enough insulin, accounts for 90% to 95% of diabetes patients. Infusion pumps have not yet been shown to be effective for Type II diabetic patients, according to the agency.
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