Medicare News
| For Immediate Release: | Contact: |
| Friday, September 24, 1999 | CMS Office of Public Affairs 202-690-6145 |
For questions about Medicare please call 1-800-MEDICARE or visit www.medicare.gov. |
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MEDICARE WILL COVER INSULIN PUMPS FOR BENEFICIARIES
Expanding treatment options for Medicare beneficiaries with diabetes, HCFA Deputy Administrator Michael Hash today announced Medicare will cover insulin infusion pumps for eligible beneficiaries with Type I diabetes.
Today's announcement of the benefit expansion is the first coverage decision made under Medicare's new coverage process announced earlier this year.
After reviewing the scientific evidence of the insulin infusion pump's effectiveness in treating Type I diabetes, the Health Care Financing Administration announced a national coverage decision to cover insulin infusion pumps. Under the new coverage policy, Medicare will pay for the pump when prescribed for beneficiaries who have Type I diabetes, also known as juvenile onset diabetes. In Type I diabetes the pancreas fails to produce insulin, the hormone necessary for the metabolism of blood glucose.
"Making the insulin pump available to Medicare beneficiaries will improve the quality of their lives. The infusion pump offers them a choice to better control their condition so that they are more active and productive," said Hash.
The decision to expand Medicare benefits to include insulin infusion pumps was made within the 90-day deadline HCFA established when it announced a new Medicare administrative process in April 1999. Medicare's new coverage process is designed to be open, understandable and predictable. The process relies on medical and scientific evidence to make national coverage decisions including medical literature and data, discussions with medical experts and technology assessment.
"We are pleased that HCFA responded promptly to a need to examine new scientific evidence about the insulin pump. Based on an analysis that used evidence-based research, HCFA decided that Medicare beneficiaries should have access to this new state-of-the-art therapy,"said Jeffrey Kang, M.D., Director of HCFA's Office of Clinical Standards and Quality.
The insulin pump permits users to maintain tight control of glucose by propelling insulin from the pump reservoir through an infusion set into a catheter inserted under the skin of the abdomen or hip.
HCFA decided to re-evaluate Medicare's previous policy which did not allow coverage of insulin infusion pumps. HCFA staff conducted a technology assessment which involved an analysis of peer-reviewed medical journal articles, consultations with the American Diabetes Association and American Association of Clinical Endocrinologists, manufacturers of insulin pumps, physicians who treat diabetes in their practices and others with an interest in diabetes treatment.
Medicare already covers diabetes self-management training provided in outpatient settings. Blood glucose monitors and testing strips are covered for all diabetic patients as durable medical equipment.
HCFA next will issue a coverage instruction, including coding and billing information, to all of its contractors that will specify an effective date that payment will become available for insulin infusion pumps for Type I diabetics.
Type I diabetes is less common than Type II diabetes which is more prevalent in the Medicare population. Type I diabetes accounts for 5 to 10 percent of all diabetes in the United States. Type II , a disorder resulting from the body's inability to make enough insulin, accounts for 90 to 95 percent of diabetes. Infusion pumps have not yet been show to be effective for Type II diabetic patients.
"The insulin infusion pump is an effective means of intensive insulin control that will protect many Medicare beneficiaries from dangerous complications," said Grant Bagley, M.D., J.D., Director of HCFA's Coverage and Analysis Group.
