Pump Access and Type 2 Diabetes
Depending on the progression of type 2 diabetes (T2D), a person may eventually need to start insulin to manage blood glucose levels. Starting insulin can have its challenges, from issues like prescription affordability to the stigmas associated with insulin usage in T2D management. However, insulin pumps are a viable solution for people with type 2 diabetes who want to simplify their diabetes self-care.
“Anyone who uses insulin for long-acting insulin basal and mealtimes can benefit from insulin pumps,” said Julia Blanchette, Ph.D., RN, CDCES and Beyond Type 1 Leadership Council Member. “Since insulin absorption is often improved with insulin pump therapy, I’ve seen people with type 2 diabetes require less insulin with more in-range blood glucose levels (BGs) with fewer lows. Pumps also allow for more accurate insulin dosing, and the ability to track dosing to help people with diabetes give more precise doses, with more information about how to make slight changes when discussing with their healthcare providers.”
But, how easy is it for people with T2D to get access to these devices? Some of the barriers to obtaining insulin pumps include the misconception that pumps are only for people with type 1 diabetes, healthcare providers assuming it’s not necessary and of course, insurance coverage.
“I think the biggest barrier is that people with T2D think that insulin pumps are only for kids or people with T1D,” said Julia. “Many people have asked about them in the past and had clinicians tell them that they won’t qualify because of their diagnosis (this used to be more true with some insulin pumps, but things are changing on the insurance side quite a bit). As a healthcare provider, I always bring up the current options and encourage people with T2D to try to get what they want by working with insurance. It is also my role to support people in starting and after starting insulin pumps. People with T2D sometimes are not given the same education as people with T1D surrounding carb counting and other self-management tasks, so I often provide education on these areas if needed before starting pumps to ensure success.”
Are Insulin Pumps Covered for People with Type 2 Diabetes?
One of the major barriers to obtaining an insulin pump for any person with diabetes is the cost. The average cost of an insulin pump without insurance can cost thousands of dollars, and that’s not including the monthly supplies needed to maintain pump therapy. However, some people with T2D can get some (or more rarely, all) of the cost of an insulin pump covered with health insurance. The extent of coverage depends on your individual plan and any qualification requirements your insurance provider has for people with diabetes. Coverage may be considered as durable medical equipment (DME) or pharmacy benefit.
Durable Medical Equipment (DME): Part of your medical health insurance plan, DME is just a categorization used by your insurance company. DME also typically covers items like back braces, canes, crutches, etc. Having your insulin pump supplies covered by the DME section of your healthcare plan means your supplies may come directly from the manufacturer or a third-party supplier. The cost varies drastically, and can sometimes depend on the brand of insulin pump you choose, as some insulin pump companies have contracts with certain health insurance providers.
Pharmacy Benefit: Sometimes part of your medical health insurance plan and sometimes separate coverage you must purchase, some insulin pump companies are able to route their insulin pump supplies through a Pharmacy Benefit plan, which can often lower your out-of-pocket cost compared to the same supplies being covered under DME. Under Pharmacy Benefit coverage, typically the customer would pay a flat monthly co-pay. Also, your supplies could be sent directly by the manufacturer or picked up directly from the pharmacy.
Insulin Pump Coverage for Medicare and Medicaid Patients
Historically, people with type 2 diabetes on Medicare have been excluded from having insulin pumps covered, even those who require insulin. However, updated guidelines state people with diabetes who meet certain conditions may have an insulin pump, insulin pump supplies and the insulin needed for the pump covered through Medicare Part B. For people with diabetes on Medicaid, coverage of diabetes supplies varies by state. For more information, please contact your state’s Medicaid office.
Tips on Getting an Insulin Pump
Your experience getting an insulin pump may differ from another person’s. To get started on trying to obtain an insulin pump, here are some useful tips:
- Research the different insulin pump companies to determine which one would be right for you. The most well-known brands are: Insulet (Omnipod), Medtronic and Tandem. Omnipod is the only tubeless pump on the market.
- Have a benefits check performed through the manufacturer or your healthcare provider to learn how much your insurance will cover the insulin pump and its supplies. Note that the amount of cost covered could vary drastically per brand of insulin pump because of contracts between the insulin pump companies and insurance companies.
- Ask your insurance company if your preferred insulin pump supplies will be covered under Pharmacy Benefit or DME. Most insulin pump supplies are covered under DME. Insulet’s Omnipod supplies are more likely to be covered under Pharmacy Benefit. Either way, inquire about possible out-of-pocket costs. You may have to ask quite a few people before you get a clear answer—working with the insulin pump company representatives is likely to get you an answer more quickly than working with your insurance company.
- If on Medicare, inquire if the insulin pump device you’re interested in is covered through Medicare Part B or Part D. Most devices are covered through Medicare Part B, however, Insulet’s Omnipod is covered through Medicare Part D.
- If denied coverage, ask your healthcare provider to advocate for you on your behalf. Discuss reasons why insulin pump therapy is more beneficial to you than multiple daily injections (MDI). Possible reasons could be: hypoglycemia (low blood sugar) prevention, hyperglycemia (high blood sugar) prevention, improved preventative care (more healthy blood sugar levels lead to fewer risks of complications), improved quality of life and fewer diabetes-related emergencies.
For more information about Insulin Pumps for people with type 2 diabetes, click here.
This content was made possible with support from Insulet, a Founding Partner of Beyond Type 2.