AllMed Webinar Helps Health Plans Learn When Insulin Pump Therapy For Managing Diabetes Is Medically Necessary

Most health plans consider insulin pump therapy medically necessary when patients meet very specific criteria. Despite the increased use of insulin pump therapy based on recommendations made by the American Association of Diabetes Educators, the American Association of Clinical Endocrinologists, and the American Diabetes Association, there is no official guideline for the initiation of insulin pump use.

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There is, however, a consensus that appropriate patient selection is critical. Patients and caregivers must be motivated and willing to work with providers in order to succeed in using this complex therapy.

(PRWEB) May 01, 2014

Technological advances continue to increase the appeal of insulin pump therapy for managing diabetes however both patients and clinicians still face many challenges as they seek to optimize therapy. During a recent AllMed webinar, Dr. Janet Beccaro, board-certified internist, discussed issues associated with determining medical necessity of pump therapy.

In her presentation, Dr. Beccaro reviewed some basic concepts about insulin pumps, which are microcomputers that provide constant delivery of insulin. She discussed the Diabetes Control and Complications Trial (DCCT), which established that intensive insulin therapy improved glycemia and delayed the onset of complications such as retinopathy, nephropathy, and neuropathy. In addition to the DCCT published in 1993, Dr. Beccaro mentioned studies that have shown potential for insulin pump therapy to minimize hypoglycemia and maintain long-term glycemic control compared with multiple daily injections.

Most health plans consider insulin pump therapy medically necessary when patients meet very specific criteria. Despite the increased use of insulin pump therapy based on recommendations made by the American Association of Diabetes Educators, the American Association of Clinical Endocrinologists, and the American Diabetes Association, there is no official guideline for the initiation of insulin pump use. Dr. Beccaro emphasized that there is, however, a consensus that appropriate patient selection is critical. Patients and caregivers must be motivated and willing to work with providers in order to succeed in using this complex therapy.

According to Dr. Beccaro, one of the main advantages of insulin pump therapy is customized, flexible basal and bolus dosing to meet patients’ individual insulin requirements while reducing the risk of severe hypoglycemia and wide fluctuations in blood glucose. She said that data suggest that fluctuations between hypo- and hyperglycemia may be more damaging to cells than elevated glucose alone.

Although there are many advantages to using an insulin pump, Dr. Beccaro noted that there are also some disadvantages. The main disadvantages of pump therapy include risk of skin infections at the catheter site, and risk of diabetic ketoacidosis from pump malfunction or absorption problems. In addition, insulin pump therapy requires more training than other forms of insulin delivery.

Insulin pump therapy gives individuals with diabetes the ability to control how and when insulin is delivered, thereby increasing flexibility and potentially improving glycemic control, which can help to prevent chronic complications. Guidelines for insulin pump therapy will likely emerge in the not-so-distant future, as data continue to uncover the utility of continuous insulin infusion. It is, therefore, essential for healthcare plans to position themselves to be able to make timely updates to their coverage criteria and medical policies in order to optimize care and treatment outcomes.

About AllMed
AllMed Healthcare Management provides physician review outsourcing solutions to leading health plans, medical management organizations, TPAs and integrated health systems, nationwide. AllMed offers MedReview(sm), MedCert(sm), and MedDirector(sm) staffing services that cover initial pre-authorizations and both internal and external appeals, drawing on a panel of over 400 board-certified specialists in all areas of medicine. Services are deployed through PeerPoint(R), AllMed's state-of-the-art medical review portal. For more information on how AllMed can help your organization improve the quality and integrity of healthcare, contact us today at info(at)allmedmd(dot)com, or visit us at http://www.allmedmd.com.


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