Newspaper article Pittsburgh Post-Gazette (Pittsburgh, PA)

Cover Life-Altering Diabetes Devices Medicare Pays for Other Insulin Pumps, but Not the the One That Works for Me

Newspaper article Pittsburgh Post-Gazette (Pittsburgh, PA)

Cover Life-Altering Diabetes Devices Medicare Pays for Other Insulin Pumps, but Not the the One That Works for Me

Article excerpt

When I was 26, I got a diagnosis that shocked me: I was told I had Type-1 diabetes. I didn't know anything about diabetes, didn't know anyone with diabetes and certainly didn't realize that I had been exhibiting almost textbook diabetes symptoms.

But I learned. Today, I'm 65 and confident in my ability to manage my disease. Which is why it was so disturbing to learn that Medicare denies coverage for the treatment my physician and I determined is best for me - an insulin pump called Omnipod. The Omnipod gives me the insulin I need and makes it possible for me to avoid going back to a life filled with the kinds of symptoms I struggled with for many years.

For millions of seniors, turning 65 and becoming eligible for Medicare are cause for celebration, knowing they'll get the care they need with most of the cost covered by the federal government. But for many of us living with Type-1 diabetes, Medicare eligibility poses a unique challenge. That's because becoming Medicare beneficiaries means that we either must pay for Omnipod out of pocket - nearly impossible for most - or abandon the insulin therapy that has kept our diabetes under control and allowed us to stay healthy and active.

Medicare's position puzzled me, especially given that most private insurers - including Highmark and UPMC here in Pittsburgh - cover Omnipod. I decided to put my legal training to work to understand why this is the case. What I found is that Congress 14 years ago gave the Centers for Medicare and Medicaid Services (CMS) the authority to cover new insulin-delivery technologies like Omnipod.

Members of Congress acted with foresight. They knew that medical innovations in the future wouldn't fall cleanly under Medicare's traditional Part B durable medical equipment category, so they gave CMS the ability to cover future insulin-delivery technologies through the Part D Prescription Drug Benefit. …

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