Expand coverage for diabetes treatment | Sally Hillerich Galla – The Courier-Journal

Sally Hillerich Galla, Guest Contributor 3:13 p.m. ET June 15, 2017

Measuring blood sugar(Photo: Maya23K, Getty Images/iStockphoto)

It might be old-fashioned, but as a young child growing up in Kentucky, I was taught never to reveal my age. Yet to understand my story, you have to start with a number: Im 65, and Im incredibly fortunate to be alive.

At the age of 24, my doctor gave me six months to live, along with one last hope: an emergency surgery to treat the endometriosis which was threatening my life. Thankfully, that surgery was a success.

But my medical journey was just beginning.

In the weeks after my surgery, I lost 30 pounds, and my vision was getting increasingly blurry. A trip back to my doctor confirmed a new, equally troubling and unrelated diagnosis: Type-1 diabetes. At the time, the outlook for Type-1 patients was grim.

Like every person with Type-1 Diabetes, not a day goes by that I dont spend thinking about and treating my disease. But there are some risk factors beyond our control, notably that Medicare, unlike nearly every private insurance plan, wont pay for some treatments that helpus stay healthy.

To start, it helps to understand that Type-1 Diabetes keeps your pancreas from producing insulin, so those of us living with the disease must inject the right amount of insulin ourselves, using everything from needles to traditional insulin pumps. Youve probably seen these pumps; a patch is connected by tubes to a device clipped to your belt or placed in your pocket.

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Devices like this come with significant drawbacks. They cant get wet, and patients with neuropathy and arthritis have a hard time connecting and re-connecting the tubes multiple times a day. However, they do have one major benefit: theyre covered by Medicare.

The device I use called an Omnipod isnt.

My Omnipod is a wireless pump; a small pod that can be worn nearly anywhere and is connected wirelessly to a device about the size of a cell phone, which doesnt have to be clipped to your clothing. Instead, it just has to be close by.

And this is where that bureaucratic thinking comes in. All other insulin pumps are paid for under Medicare Part B because theyre considered durable medical equipment.

But the Omnipod isnt.

Thats because the Omnipod is different. Each of the pods lasts three days. Once its supply of insulin is used up, you replace it with another. You keep the cell phone-sized transmitter, which connects wirelessly to each new pod. Yet even though it has been approved by the FDA for 12 years, Medicare still wont cover it.

Medicares non-coverage policy is in conflict with Congresss intent, which was to promote medical innovation. Back in 2003, they passed the Medicare Modernization Act, which made it clear: new technologies not covered under Part B should be covered under Part D, which covers medicines. Medicare hasnt used that authority to cover the Omnipod either. But it should.

Because Omnipod isnt covered under Medicare, the Federal government is forcing seniors like me to abandon the treatment we need.

Now Im fortunate: After paying out of pocket since I turned 65, I recently found out that my Express Scripts Medicare Advantage plan has decided to stop mirroring Medicares policy. Thanks to that decision, I will get the coverage I need. But millions of people arent as fortunate they rely on other Medicare and Medicare Advantage plans where Omnipod still isnt covered.

Every major diabetes patient and medical advocacy group agrees: There should be no reason why the Omnipod remains the only FDA-approved insulin pump not covered by Medicare. Theyve urged the Centers for Medicare and Medicaid Services to cover the Omnipod. And Im urging them now, too.

Medicare should cover Omnipod, because it is a critical part of my medical plan. I shouldnt be forced to lose it just because Ive turned 65and neither should any other senior.

A small business owner, Sally Hillerich Galla is a 40-year veteran of the health insurance industry who lives in Eastern Jefferson County with her husband, Patrick.

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Expand coverage for diabetes treatment | Sally Hillerich Galla - The Courier-Journal