Insulin pumps to be covered under Medicare
New benefits will be available April 1
The U.S. government has changed its policy to bring insulin infusion pumps under the umbrella of Medicare.
The Health Care Financing Administration (HCFA) announced the change in policy Sept. 24, but the new regulation won’t take effect until April 1, 2000. A HCFA spokeswoman says the pumps cost approximately $3,000 each and an estimated 1,000 Medicare beneficiaries will meet the criteria to have a Medicare-reimbursed insulin pump.
Any patient who has not previously used an insulin pump must meet these qualifications:
• be a Type 1 diabetic;
• receive at least three insulin injections a day for at least six months;
• need frequent self-adjustment of insulin dosage as a result of frequent blood glucose monitoring for at least two months prior to obtaining a pump;
• plus meet one or more of the following:
— HbAlc above 7.0 %;
— history of recurring hypoglycemia;
— wide fluctuations in blood glucose before mealtime;
— dawn phenomenon with fasting blood sugars frequently exceeding 200 mg/dl;
— history of severe glycemic excursions.
HCFA officials said the change in policy was based on new scientific evidence and was reached after analysis of peer-reviewed medical journal articles, consultation with the American Diabetes Association, the American Association of Clinical Endocrinologists, manufacturers of insulin pumps, and physicians.
"The insulin infusion pump is an effective means of intensive insulin control that will protect many Medicare beneficiaries from dangerous complications," said Grant Bagley, MD, JD, director of HCFA’s coverage and analysis group, in a written statement.
HCFA statistics show that 153 private insurers currently cover insulin infusion pumps under similar criteria.
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