Opinion Columns & Blogs

How do you survive if you can’t afford the medical advances that let you live a normal life?

The Omnipod
The Omnipod

For all of my career and most of my life, I have been in the business world. After decades in corporate America — including serving here in Georgia as the Global Director of Sustainability for a company which holds over 5,000 patents worldwide — there’s been one thing I’ve learned for sure: if you’re not willing to innovate, you’re doomed to fail.

Somebody, it seems, forgot to tell the federal government.

Innovation is everywhere you look in this country, and nowhere is that more true than in the area of medical technology. Georgians understand this well: as the home of the Centers for Disease Control and Prevention, Atlanta has been on the front lines of medical advances for years.

But access to that innovation is out of reach for seniors living with Type-1 diabetes because Medicare refuses to cover a groundbreaking, FDA-approved, wireless insulin pump called Omnipod. Today, many seniors are being forced to revert back to treating their diabetes with older, 20th century technologies.

I should know, I’m a senior living with Type-1 diabetes. I’m fortunate enough to be able to pay for my treatment out-of-pocket, but there are so many who can’t.

Living with Type 1 diabetes has been a challenge for me on many fronts. For years, I was like so many who wrongly thought of diabetes as a disease that came as a result of poor eating habits and little exercise. I was healthy and still running 15 miles a week at 52 years old when, in the middle of being treated for a sudden cancer threat, had a new doctor ask me: has anyone ever told you that you have Type-1 diabetes?

In fact, they hadn’t. So I immediately started learning everything I could: that Type-1 diabetes is a disease where your pancreas isn’t capable of producing the insulin your body needs to regulate your blood sugar. That there was no cure. That treatment required finding a way to inject yourself with insulin every day in order to live.

After trying other treatments, my doctor introduced me to the Omnipod, and I’ve never looked back. With the Omnipod, I didn’t have to worry about tubes or needles — instead, a small device I could keep in my pocket or a nearby bag connected to a waterproof “pod” that attached just about anywhere on my body. The most important thing, for me, was that it allowed me to take care of myself while I traveled. This meant that I was no longer forced to choose between my job, which required me to be on the road, and my health.

Visit any state in America, and you’ll find other seniors who are just like me: after years of exploring other treatments, they’ve come to rely on their Omnipods. They’ve made this treatment choice with their doctors, and it has made a tremendous difference in their day-to-day lives.

But even though Medicare covers every other FDA-approved insulin system, it won’t cover the Omnipod. So many seniors living with diabetes are being forced to abandon this technology or pay for it out-of-pocket, which is not a viable alternative for most on Medicare.

This isn’t how it was supposed to be.

14 years ago, Congress passed the Medicare Modernization Act, and added a drug benefit for Medicare beneficiaries. Knowing that at some point in the future, there might be a new way to deliver insulin that might not be covered as Durable Medical Equipment under Part B, they were forward-thinking enough to add a provision specifically stating that these new insulin delivery technologies should instead be covered under the Part D Prescription Drug Program.

In other words: they wanted to encourage innovation and be certain that all new insulin delivery technologies would always be accessible to Medicare beneficiaries. They wisely provided those in charge of the Department of Health and Human Services and the Centers for Medicare and Medicaid Services with the authority necessary to cover innovations like the tube-free, wire-free Omnipod. But so far, the people in charge haven’t taken action.

If there’s a light at the end of this tunnel, it’s the fact that a fellow Georgian — Dr. Tom Price — is now the Secretary of HHS, and has ultimate responsibility for CMS. As a doctor, a congressman, and now HHS Secretary, he has always felt that government shouldn’t be in the business of interfering in the relationship between a patient and their physician or stifling medical innovation. And he knows that to address the health care needs of this nation, we need the technology of today and tomorrow.

I remain hopeful that under his leadership, HHS and CMS will at long last implement the law as Congress intended. In doing so, they will be supporting the kind of innovation which will help seniors like me here in Georgia, and in communities throughout our country.