Unless you are living in an underground bunker, you know that Medtronic Diabetes announced yesterday that the MiniMed 670G hybrid closed loop system has been approved by the FDA with anticipated shipping in the spring of 2017. Here’s a link to the press release if you haven’t read it yet.
Am I excited about this? Absolutely yes!!! Will I purchase it? Absolutely not!!!
You may think that I won’t purchase this because I am currently a Dexcom and Animas user. You may think that I won’t purchase this because I’m mad about the United Healthcare/Medtronic agreement. You may think that I won’t purchase this because “The Cure” will be here in five years. No, those are not the reasons. What is preventing me from pursuing this device is my next pump and CGM is ⚡️⚡️⚡️⚡️
Those lightening bolts are supposed to grab your attention and make you sit on the edge of your seat as I explain my predicament.
My issue is that I am going on Medicare in April 2017 after having my current pump go out of warranty in December 2016. I long ago satisfied my deductible for 2016 and if I purchase a pump before the end of the year, it will be at no cost. The individual health insurance market in Minnesota is in chaos and I plan to purchase the cheapest insurance plan possible for January through March 2017. It will be expensive despite a high deductible. No way can I purchase a new pump in that time frame.
So my choice is to purchase a pump in early December or enter 2017 with an out-of-
warranty pump and wait until Medicare. A naive advisor might suggest that I buy the Medtronic 630G in December knowing that those buyers will be the first in line for the 670G pump when it is released in the spring. But guess what! Once you get on Medicare, it is against Medicare law for beneficiaries to participate in upgrade programs. So if I purchase a 630G, that will be my pump for the next 4-5 years because I will not be allowed to upgrade to the 670G.
A Medtronic representative told me on Saturday that the 630G is now being reimbursed by Medicare. The sensors are not Medicare-eligible, but at least the pump is covered. If I wait hoping to purchase a 670G after April 1, the most likely possibility is that it will not be covered by Medicare for quite a while. Hopefully I am wrong on that.
I am excited that the FDA has approved the MiniMed 670G. Medtronic is not calling it an artificial pancreas, but it is an important step on the journey to complete insulin automation. That is good for all of us excited about the future of diabetes technology.
But for me, it is not in the game. My reimbursement scenarios just don’t fit the timing of this release. Anyone who reads my blog regularly knows that I currently use Dexcom after several unhappy years with Medtronic SofSensors. The Guardian Sensor 3 that is part of the 670G is many generations removed from that nightmare and I would be open to trying them. But it would be too big a leap of faith to move back to Medtronic without a trial run. Maybe that will be possible in the future when hopefully, hopefully, hopefully CGM/pump systems will be reimbursable under Medicare.
Today my options are too tangled and uncertain to make the MiniMed 670G part of my plans. But I will still camp out in the grandstands with other diabetes advocates yelling “Congrats!” to Medtronic. We live in a golden age of diabetes tech. Unfortunately we also live in a stone age of diabetes reimbursement for those of us who are approaching age 65 and older.
Test Guess and Go 
I did not know that upgrades were off limits for Medicare recipients! Seems like you’re getting the bad end of every deal. Hope your prospects improve soon.
I am surprised that Medtronic told you that the 630g is covered by Medicare. When I got the 530g in 2014 it was not covered. When I first went on Medicare in 2012, I had a pump that was still under warranty. Medicare will require certain information from you to allow supplies for the pump, including BG Logs prior to you being eligible for Medicare to prove that you tested frequently. I used my CareLink Data and it was accepted but I was not made aware of this necessity until the third step of the Medicare Appeals Process, the ALJ Hearing. Any information I got was always at the ALJ step in the Appeals Process. They kept denying my pump supplies as not medically necessary. If your doctor does not already say in your progress reports w\hen you visit that you must test however many times a day per day, they will not allow more than three test strips per day. There are many things that I was unaware of befpre Medicare kicked in and I am still learning.
I was at a diabetes event last weekend where there was a Medtronic booth. One of the reps told me that the 630G received Medicare approval with the last couple of weeks and that one was able to purchase it without the CGM portion. My plan is to purchase a new pump in December, but I do know that I will have some hoops to jump through to start receiving pump supplies once I am on Medicare. I also know about the problem with test strips. I expect that it will take a long time to get everything figured out….
As always, Laddie, your comments are timely and informative. This may eventually have relevance for me. I may need to make the switch to Medtronic. As you know I am currently using the Omnipod pump as well as the Dexcom5 CGM. I have been generally pleased with both. BUT, yesterday, for the first time in the 7 years that I have used the Omnipod system, my PDM (Personal Data Manager – the cell phone size device that wirelessly operates the pump) failed! I could not test, or look at my basal rate or review my bolus calculations. It was awful. My backup Lantus had expired 2 years ago. Two old meters that I had kept did not work either. The Omnipod rep told me over the phone that they could get a new PDM to me by today. But I still needed to manage for the next 24 hours. It took several hours of phone calls to my endocrinologist, 2 trips to the pharmacy and one to my Dr’s office to finally get back up supplies to use until my new PDM arrives, hopefully today. Big lesson learned on having a BACKUP supplies for whatever system one has. Thanks again for your great blog and all the good info you provide.
I wish there was a better answer, NOW, relating to Medicare and Medicaid. Know it’s coming at some point relating to CGM coverage, but probably not before April, and that makes me sad. I’ll make sure to pass along anything more I hear on this… but thank you for sharing this, Laddie.
That Medusa Medicare rears its ugly head even amidst the good news of the closed loop system. I used an upgrade BEFORE Medicare to a 630G and am still using my sensors. However, it is now time to order more Enlite Sensors. I have decided to make the huge effort to go through the Medicare appeals process to try to get them covered. That is what I am holding out hope for. I appreciate reading about everyone experiences with this tough matter. Congress can’t even pass a budget so that we will know what the Medicare rates will be for 2017!!
It breaks my heart to see articles like this where it’s all about access and insurance. I don’t understand how it got so complicated in the US and how people don’t rise up and demand something better. It’s so stressful for you to be excited about this new technology but have no real clear path to getting it. It’s all so silly. Sigh.
And as a long-time diabetic who doesn’t keep up with technology, I thought CGMs communicating with pumps was already a thing? What exactly is new about this one that people are so excited about?
Medtronic offer me a 630G pump at no cost since it was approve for Medicare. Plus an upgrade to the 670G in April 2017 when they come out. After a few days of thinking about it , they withdrawn the offer of upgrading to 670G for 13 months. Since Medicare makes payments on the pump for 13 months instead of paying the company in one sum that makes sense.while the offer was withdrawn. But Medicare with not pay for the new 670G and since Medicare does not allow for upgrade programs then I think I was fed from Medtronics alot of sales pitch. For that I cancel getting the 630G until the 670G comes out then file under Medicare for it.
Thanks for your comment, Don. We all have to do our homework in addition to what sales reps tell us. Whether they are just uninformed or purposely stretching the truth, you know that their job is to sell pumps. Then if there are problems with Medicare or other insurance farther down the road, it becomes our problem.