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Monday, May 9, 2016

Goodbye, Medtronic (From A Once-Loyal Pump Customer)

I am mad, sad, confused, conflicted, and utterly disappointed.

All because of the recent UHC policy change about making Medtronic it's preferred, exclusive in-warranty pump supplier.  My head has been spinning and my emotions have run the gamut, wondering what I truly think and how this actually affects me. No, I don't have UHC at the moment and I have found the MedT pump the best choice for me.

However, I can no longer personally support you as a customer, Medtronic.

Photo from A Sweet Life.
This is tough for me, both as a patient who likes your pump, but also given the professional hat I wear as a diabetes advocate and journalist covering this industry and topic specifically. Make no mistake, I'm trying to draw a line here between the personal and professional as much as possible. I know both professionally and personally there are good people at Medtronic trying to do good in this world, and I hope this doesn't diminish that.

But in the end, I am a patient and diabetes device customer first and this is where my decision is based. This is completely a personal decision, and my POV there is what I'm writing here.

This may not be a big day to anyone other than me, as I'm only one of millions of patients and you have a whole array of products and people beyond just me and my insulin pump. Yet, I think it's important enough to tell you what led me to this decision. And I want others to know, too. So, I will not go gently into the night.

For the past 15 years, I've been insulin pumping and it's been a great piece of technology for me. As a young man in my final year of college, I finally agreed to consider an insulin pump instead of multiple injections per day. At that time, two pump choices existed -- Disetronic (now Roche) and Minimed (now MedT).

I clearly remember my endo at the time telling me the best insulin pump out there was Minimed, and I should make the move to start on that pump. Knowing I had an option, I examined both devices. I also remember my MM trainer at the time, telling me that pump was the best but that clearly I had a choice between the two on the market then.

My preference was MM 508 at the time, which coincidentally was 15 years ago this month. (So, hey, happy Pump Anniversary to me!)

We've been together in various pump generations for the most part since then, even when Minimed got bought by Medtronic and a lot changed in the company culture. Still, we've endured for most of those years... Only once, I deviated for about a year to another pump that's no longer on the market, but that change didn't make me happy and I saw myself not using the pump in the most effective way. My A1C rose in what I believe was a direct result of that and I remember being so frustrated with that other non-MedT pump that I wasn't using it for all of its effectiveness.

Before long, I fled back to my trusted Medtronic Minimed pump.

I was glad to have the choice. Through the years, many more pumps have become available and I've been lucky enough to try them out to see if they were any better for me. None of them were as good as my MedT pump and the company behind this device, I determined.

Now, it's not so clear based on your company business decisions more than anything.

After struggling with the news of this UHC-MedT partnership, and searching my soul, I can no longer continue as a Medtronic customer -- no matter what I feel about the insulin pump.
 
Medtronic, I just don't trust you any longer. I do not feel you represent me in allowing my doctor and I to choose the device that best works for me

Rather than relying on patient choice and winning a fair fight, you are forcing hands and using the insurance coverage game as a way to hook more people. Yes, people still can choose a non-MedT route per se. But I ask you to consider this:
  • How many will just give up and not fight when they're told by insurers that "We only cover Medtronic pumps in network."
  • How many doctors won't have the time to wage the battle to demonstrate "medical necessity" for this insulin pump, and instead will just encourage patients to choose MedT because it's the market leader and a good piece of tech that's been around for decades?
  • How many patients will hear "more expensive cost for out of network insulin pumps," and see the higher dollar figure and opt for what's technically more affordable?
  • What about all those insurance plans that are, more frequently these days, totally wiping out any "Out of Network" coverage and requiring you to pay the full price out of pocket unless you go with an in-network brand? (My current Michigan-based HMO currently does this, in saying I have no coverage for anything out of network. Luckily, my insurer doesn't at the moment have an exclusive agreement with any insulin pump or CGM company, so I'm OK there for now... Yet, things change and my insurer will probably change next year. So, yikes.)
In essence, you are eliminating choice and access.

I have now seen how you're willing to ignore what patients actually want and do not respect that it's our choice to make.

I'm afraid that before long, this same rationale will be carried over to my beloved Dexcom CGM and I'll be forced to pay a higher cost simply because it's not Medtronic. I will be penalized for choosing what I believe is a better technology, and I just hope I'll be lucky enough to fight the fight and argue for my preferred technology and then I'll be able to afford the higher price-point.

Based on current tech, I will not use the Medtronic CGM.  I'd rather not use a CGM, which I understand and fully grasp would likely have a negative effect on my health, keep me less in range, and ultiately lead to higher A1Cs and potential life-threatening situations. But I see the Medtronic product is inferior, and I exercise my ability to choose my preferred brand -- or to not use one entirely if my choice is limited.

Eventually, I feel this lack of choice could also happen with closed loop tech. Medtronic will likely make it to market first, but I worry that this "we are the preferred choice" mentality will carry over to those competing systems in a way where other APs won't be able to fight a fair fight, and that could even cause them to go under. That's not cool in my mind.

So much is being written about this within the Diabetes Online Community and beyond, and it's a lot to soak up. Particularly, a few D-peeps have written posts that resonate the most with me and had me nodding my head:

This one by Ally at Very Light No Sugar, where she shares this point:
As we over-emphasize cost-cutting, we must be careful not to also snip choice and patient autonomy. Reducing costs sounds great in the short-term, but we cannot disregard the long-term. If patients’ health is compromised by inadequate access to resources, all the costs that insurance companies may have saved upfront will later be seen in hospital bills and subsequent treatment.
Scott at Rollin in the D also writes a Chain of Thoughts where this point stood out to me:
What is the underlying premise that makes UHCs and MDTs actions so wrong?  This is not about choice. This is not about diabetes. This is about insurers playing doctor, and choosing the best treatments based on financial, rather than medical knowledge. The problem extends well beyond insulin pumps and well beyond diabetes. The argument that needs to be made is this: insurers should not be allowed to dictate treatment. The argument needs to be made at a regulatory, governmental level.
Scott also speculates on some points in trying to connect dots and the bigger picture, and while neither of us know whether any of that is actually true, it makes a lot of sense to me and really scares the fuck out of me about Big Brother going all SkyNet in the healthcare arena and sharing info with my insurers without my express consent. It freaks me out that I may be slowly being turned into a guinea pig. Honestly, it any of that is true, then I kind of want to distance myself from this now as much as possible before it gets crazy and there's no way back.

Something else comes to my mind in all of this...  I've also heard talk that MedT recently pulled sponsorship from a beloved organization and summer conference, one that helps people in a way that can't even be put to words. If you check out the event sponsorship page, there's clearly no mention of MedT -- that's striking as the company has been a sponsor of this particular conference for more than a decade.

Whatever Medtronic says officially about this, I'm also smart enough to realize the timing, that just very recently the organizer of this non-profit hosting the conference was publicly heralded for being a part of a new startup developing a cool closed loop system -- one that will, eventually, be a competitor to MedT.

Again, it's all speculation on my part, but I see no coincidence here. And it speaks volumes, if true, in a way that shows MedT cannot draw a line between psycho-social support in our D-Community and its own bottom line. Especially when every other company in the diabetes industry apparently has this ability and continues sponsoring the conference.

This has all been weighing on me, and I've decided to start exploring my options on insulin pumps. I even took the weekend to ponder whether this is really what's best for me personally, and if I feel this strongly about making a change. The answer: YES.

A few days after this whole controversy erupted and the JDRF responded with its stance on supporting choice and patient access, I wondered when my current MedT pump warranty expires. I couldn't find this information in my own documentation at first, and so I called your company to ask that simple question.

Like a smack in the face, I heard an automated message on the call where you tout this new UHC partnership. WTF, seriously?!??

You'd think that with all the fuss over this right now, you'd take a step back and ponder the potential PR disaster you're currently maneuvering. And just maybe, you'd think twice about flaunting this in our faces at least for the moment, while emotions are so high and some of us are on the fence about how we truly feel.

That sealed it for me, and you lost me as a customer, Medtronic.

Of course, I still need to figure out what device I'm going to turn to and when exactly that will happen.

But I cannot remain a customer of a business I so deeply despise for its business practices. Whether it's a smart biz move or not, I don't care. You are pulling the strings to screw with choice, effectively making it more difficult for people with diabetes to obtain the device they really want and will really help them more than yours. It's one thing to win by having the best tech, by providing the most innovative tools. That's what the free market is all about.

Sure, I get that you're not the first to make this move. Others have done it for years in healthcare and diabetes specifically -- insulin, medications, test strips, and so on. To me, this is different because it's caught so much attention and highlighted the bigger problem of access, and because you're the big player on the market doing this now, it's serving as a potential catalyst for change. And this isn't the only issue factoring into my decision; if it was, I might not be ready to say goodbye right now.

I am only one guy, one insulin pumper who's business you have lost. Am I being too emotional and knee-jerk on this? No doubt, I am probably being naive in thinking that a company will do the right thing over its bottom line, thus "shooting itself in the foot" to some extent by helping competitors. It's all complicated and I don't fully know what the answers are and maybe I am being overly-dramatic in making this choice.

But again, it's my choice. And it's one I can currently afford to make, whereas in the future I might not have that chance.

Just like if I walk into a big chain store, and that everything I need and want is in the aisles, but I see every other customer being treated like shit. Even if I'm being treated like royalty, I can see what's happening and know it's only a matter of time before I am treated like shit, too. And so, I choose to go shop somewhere else.

Rest assured, Medtronic: This is not because I don't like your insulin pump, and don't trust you're making better next-gen pumps and CGMs. This is all about your business attitude, and so I say goodbye.

Instead, I will move toward another company that cares more about this community and seeing choice exist for those who want and need it. Those that recognize they are one option, but believe they're the best and are willing to let customers make that case for them instead of cutting our legs out from under us.

Even if that device doesn't have all the best features in my eyes, at least I can look myself in the mirror and know that I am not supporting with my dollars a company that doesn't truly care about me and others in this D-Community.

Be clear, too, Medtronic: I don't want you going away as a choice for people, even if you want all the other choices taken away from us. #DiabetesAccessMatters.

Right now, I am taking an insulin pump break. I've done this before and I've been talking about doing this for the past few months, and right now I need a pump hiatus regardless of all this other business-related stuff going on. This all just motivates me to actually unhook my pump and go back on Lantus pens and Humalog for awhile. In the past, that's helped me get back on track with diabetes management so I'm hoping for that again over the next few months.

So here I am, with my Medtronic pump in the draw for the near future. I am sad, mad, confused, conflicted, and disappointed. But ready to move forward with what's best for me. Most importantly, it's on my own terms.


6 comments:

  1. Brave and powerful post, Mike. Thanks for speaking out.

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  2. We also had this happen with our Care1st plan last year. Tandem is the only company they will cover and they literally sent our information to the Tandem rep when our Medtronic pump was denied by Care1st. We were forced onto t-slim, so just understand that this is not just a Medtronic problem. I found it insulting that Tandem "broke" the news considering that they do the exact same thing and have done it for over a year. Verify with Care1st if you don't believe me. I just thought you should know in order to provide more contect to your article.

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  3. This is no different than my insurance company deciding which "preferred" insulin I must use. Even though another brand works better for me. I am an RN and the business side of healthcare frustrates me as well and even ties my hands when taking care of certain patients. Try to take it all in stride.

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  4. For the most part this will not affect most of us and for me at least that is the point of the community’s outrage. I love that we have come together to work on these issues. Thank you for writing an excellent blog, Mike.


    I referred your blog to the TUDiabetes web page for the week of May 9, 2016.


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  5. BRAVO & straight from your heart, Mike.

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  6. GREAT blog, Mike. I feel the outrage and this one doesn't affect me directly! However, I am unable to get the pump of my choice nor the insulin of my choice, nor do I have coverage for CGM ... it's beyond insulting. It's frightening and manipulative and, in the end, never serves the patient. Thanks Mike!

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