Too many choices?

Yep patient choice in the insulin pump space sure is being stifled. Let’s count’em up – Medtronic – Tandem – Insulet are available here in the US – Roche has begun selling the Solo in Europe and we have Onduo – CellNovo – Bigfoot – Lilly -all working on their own way cool whiz bang systems. It seems you can’t swing that poor dead cat without hitting an insulin pump company. Now we will not go into our normal rant about how many of these insulin pump wannabes are paying a heavy price to get their heads bashed in. However, what will say is with all these choices how will any of the newbies stand out form the crowd.

Let’s go even further as besides all the “smart” pumps we have a bunch of dumb ones. Valeritas, CeQur quickly come to mind. But let’s not stop there what about all the “smart” insulin pens – Companion Medical – Sanofi – Bigfoot – Lilly – Novo Nordisk are just a few in this category. And my goodness we do not have enough space to list every whiz bang way cool app that are supposed to help patients’ better dose their insulin.

Now what most of the insulin pump wannabes will say is that they really aren’t competing with the established pump players but are going after insulin using Type 2 patients. An area where no one and we do mean no one has been successful. But this won’t stop them for giving it a go.

Let’s put aside the many reasons why this group is so difficult to convert to insulin pump therapy and add one more, long-acting GLP-1’s. Think about this just for moment from the perspective of the patient and the patient’s healthcare team. What’s the shortest distance between two points? What’s the easiest therapy regimen to learn? And think about what will happen when an oral GLP-1 is on the market.

We know that logic does not play into any of the decisions made by these insulin pump wannabes but seriously how many of these suckers do we really need. Has it dawned on any of these people that only 30% of the Type 1 population uses an insulin pump. That the insulin pump market is barley growing organically. If anyone would bother to do the math the only reason Medtronic has been so aggressive with their growth estimates has nothing to do with the market expanding and everything to do with converting Animas patients to a Medtronic system.

It’s not time for yet another history lesson but go back 10 or 15 years and look at who’s come and who’s gone in the insulin pump space. Need we say more?

Oops just remembered that Ypsomed also has a way cool whiz bang pump too. But we digress. Damn what about Sooil almost forgot about them. We know we’re likely forgetting some companies but we’re pretty sure everyone is starting to get the point, that is unless – well we won’t say it today as we want to be nice.

Now let’s assume just for a moment that we live in the real world and all these insulin pump wannabes are not philanthropic organizations. That they are not doing this for grins and giggles. That they want to make money. Just how the hell are they going to do that?

Listen we will fully acknowledge that we aren’t the sharpest tool in the shed, but neither are we dumber than a box of nails. And let’s take away the fact that one company effectively controls over 70% of the market. Or that the other two established players have pretty good systems too. Will someone please explain how the hell these insulin pump wannabes will make money.

Of all the wannabes we would think that Bigfoot has the best chance but beyond them it’s a crap shoot. Sure, our friends in the Valley have gobs of money but they have a huge handicap – they are partnered with Sanofi. Our Midwest friends in Indy also have gobs of money but they have a similar handicap – they are a DRUG company and history tells us DRUG companies flat out suck when it comes to devices. Everyone else lacks the resources to compete or in the case of Roche have demonstrated an uncanny ability to turn gold into sand.

Let’s say by some miracle, and believe us it will take a miracle, that the insulin pump market does an about face and starts growing again. Does it not make sense that the established players not the wannabees would benefit the most? Is that not common sense? Well we can’t have any of that can we, nope not in our wacky world.

Ok we’re rolling so think about this – is there an unmet medical need here? The answer is a huge NO. Insulin pumps are becoming commodities.

Now think about this for moment the only people who want all these choices are payors. Payors love all this competition as it drives their costs lower. They know how things operate in the real world and how all these wannabes will pay dearly to get on formulary. They can use all this competition to pressure all the existing players to lower their costs. Hence the reason Medtronic is doing whatever they can to lock up their formulary position – the folks in Northridge ain’t dim.

Are we getting a clearer picture yet?

We are not against any company from entering this market. What we are against is stupidity and quite honestly there’s more than enough stupidity to go around here. We have given up wondering whether any of these wannabes bothered to do even the slightest due diligence. For had they done even a little they would have found out that there are more than enough toys in the toy chest. That most of these toys do the exact same thing the exact same way. THAT IT IS NOT ABOUT THE DAMN TOY IN THE FIRST PLACE.

Let’s conclude by giving a high five to the JDRF and the West Coast Mafia who once again accurately predicted that patient choice was limited when it came to insulin pumps. Yep right again guys.