What are the repercussions for a child to become dependent on a machine? The insulin pump seems awfully expensive for what it does. How can these companies justify charging up to $6,000 when we can now by personal computers for $600? What happens if insurance coverage is lost? What about machine replacement with ever changing technology?

The justification for the cost of the insulin pump probably has several factors. First of all, the research and development costs for the devices, the clinical trials, patents, etc., etc., are enormous. Personal Computers may cost $600 now, but they started at thousands. Indeed, if it weren’t for microtechnology brought by the PC, I’d guess that the pager-sized pumps would not be here today. Besides, the pump is a life-saving device — but only a machine. Mechanical problems occur so the pumps have built in safety checks, alarms, monitoring for irregular doses, etc.

An additional factor probably is simple supply and demand economics. One does not need an insulin pump to care for diabetes — shots have been around for a long time! Certainly, pumping is a great way to go because it better mimics normal physiology than shots, and deliver a basal/bolus regimen of receiving insulin more precisely, but certain types of insulin combinations can also use a basal/bolus approach.

I do not have stock in any of the pump makers, but pumping is an excellent way of giving insulin. However, it is not the only way, and it is not for everybody. There are advantages and disadvantages. [ED: See Is pumping for you?.]

The insurance issue is a good question! I have had several families wishing to “upgrade” their pump to a newer pump with more gadgets/options but their first pump is still in working order so insurance will not pay. However, your automobile insurance won’t pay for you to upgrade from your Chevy Nova to a Mercedes either! Some of the pump makers have an “uninsured” or “under-insured” program to help defray pump costs. Ask your pump representative or search on the Internet.

DS
Additional comments from Shirley Goodman, diabetes nurse specialist:

While I can’t answer for the manufacturers and distributors of insulin pumps as to their costs and marketing strategies, I can certainly understand the concerns faced by families when they evaluate the financial implications of diabetes management. Pump therapy is more expensive than injection therapy, and for under-insured families, part of their decision making about pumps is based on finances.

When a family loses private insurance, in many states, the children are eligible for insurance administered by the state. The cost of the insurance is based in part on the assets of the family. These public insurance programs do provide financial support for insulin pump therapy and are an avenue for the uninsured child.

Different pump companies have policies about upgrading equipment when new technology becomes available. I would recommend that when any family is looking at insulin pump therapy and deciding on the pump that most meets their needs, that families incorporate these upgrading policies into their decision making. Additionally, as the pump reaches four to five years of use, many insurance companies are willing to provide financial support for a new pump.

SG
Additional comments from David S. Holtzman, Esq.:

How ironic that a person who invests in Internet service so disparages miracle medical technology for their children!

Coverage of insulin infusion pumps and their supplies can vary greatly depending on how your family receives coverage for its medical expenses and where you live. Pumps and supplies are covered through the durable medical equipment [DME] section of an entitlement plan, HMO contract or insurance policy. Medicare covers insulin pumps for people with type 1 diabetes who meet specific utilization criteria. Your physician or local Medicare office can help you learn what that criteria is. Medicare covers 80% of the cost of the purchase of a pump, minus any unpaid annual deductible. They will also cover 80% of the cost of pump supplies and the insulin cartridges used by the pump. If the pump needs repair, Medicare will pay for service but will often balk at the cost of rental of a replacement pump. Look to the pump manufacturer to provide a temporary replacement.

Some state Medicaid programs also cover insulin infusion pumps. However, the coverages and utilization guidelines will vary by state. If you are a Medicaid recipient, it is important to learn from the program exactly what is covered and how coverage of the pump supplies is covered under the DME benefit.

Private insurance coverage of insulin pumps is equally variable. Many states require that health insurers cover the cost of insulin pumps and supplies. However, there are at least 10 states in which it would be difficult to get pumps covered. In addition, self-funded or employer sponsored ERISA plans are not required to provide coverage for insulin pumps, although many do. Again, read your plan benefit booklet carefully for coverage of pumps under DME. In addition, if you belong to a managed care organization, be aware that most will require a utilization review of your physician’s recommendation for the pump before you embark on having the pump fitted. Some plans cover DME items at 80% while others only cover 50%, with similar coverage for pump supplies. If your plan covers the pump, it will also cover repair of the pump in case of malfunction. If a person on the pump loses their health care coverage, there is no liability on the part of the plan or the pump manufacturer to continue support for pump usage until new coverage is established.

DSH
Additional comments from Dr. Jim Lane:

Your questions are reasonable ones. I would respond first by saying that I prescribe pump therapy for my patients. I use it because it seems to work very well. In those that have access to this therapy, I believe it provides increased flexibility in their life, better control, and a more satisfied patient (compared to intermittent injections). It is a tool.

Price setting for these pumps is beyond my control. They are expensive. However, I will tell you that more and more insurance companies are less concerned about the price of the pumps up front, compared to the costs of poorly controlled diabetes down the road. In other words, if you can make the treatment improve glucose control, you may be able to justify the expensive treatment down the road.

Like all machines, they do wear out. Most companies have trade-in policies for upgrades. Not all insurance companies have similar policies about trade-ins.

I do not have a concern about “dependency on the pump” because patients with type 1 diabetes are already “dependent” on insulin therapy.

JTL