Effect of Medicare (CMS) Insulin Pump Policies in T1D

Abstract

CMS has numerous requirements for insulin pump coverage and obtaining disposable supplies. T1D Exchange surveyed 241 adult T1D patients who had been on a pump with CMS coverage for at least 6 mo on their experience. Median age 67, 64% women, 93% white, 16% on disability, median T1D duration 42 y, median pump use 15 y, mean A1c 7.0%, 82% on pump before starting CMS, 95% current pump users. Of those starting a pump while on CMS, 50% reported challenges, most commonly cost of the supplies (29%) or the pump (24%). Issues with obtaining supplies reported in 57.5%, the most common problems being delays releasing supplies (29%), difficulty getting paperwork completed (23.5%), and seeing an HCP face to face every 90 days (18%). When asked if they had changed pump behaviors because of possible or actual supply delays, 39% answered yes. Most common responses: leaving site in place >3 days (64%), explicitly to reduce cost (33%), reused pump supplies (34%), used injections to supplement pump (23%), or temporarily stopped pump (17%). Responses to a question about any adverse effects of these actions are shown in Table. On their experience with CMS compared to prior insurance, a minority thought it was somewhat (4%) or much (6%) better; 31% about the same; 28% found it somewhat worse, and 31% found it much worse. Conclusion: current CMS pump policies cause increased adverse pump behaviors and outcomes in T1D, and CMS is perceived negatively compared to prior insurers by 59% of respondents.Adverse outcomes from changes in pump related actions, n=88QuestionfrequencypercentQuestionfrequencypercentNone2122.8Hospitalization66.5Higher blood sugar3740.2More hypoglycemia1516.3Infection at site1314.1Increased anxiety or frustration3942.4Pain or irritation3032.6Required emergency pump supply shipment1718.5More scarring2527.2Needed emergency supplies from local source1314.1More erratic blood sugar4245.7Other11.1Diabetic Ketoacidosis88.7No change needed22.2 Disclosure N.B. Argento: Speaker's Bureau; Self; Dexcom, Inc., Novo Nordisk Inc.. Advisory Panel; Self; Eli Lilly and Company. Speaker's Bureau; Self; Eli Lilly and Company. Advisory Panel; Self; Unomedical a/s, T1D Exchange. Speaker's Bureau; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Janssen Pharmaceuticals, Inc.. Advisory Panel; Self; Senseonics. Consultant; Self; Intuity Medical. J. Liu: None. A. Hickey: None. E. Gautschi: None. A.H. McAuliffe-Fogarty: Advisory Panel; Self; Novo Nordisk Inc..