Anthem is cutting support for breast pumps nearly in half, angering breastfeeding advocates

Virginian-Pilot (Norfolk, VA)

March 12--Anthem plans to nearly halve what it spends on electric breast pumps, a move advocates fear will lead to inferior equipment and deter new mothers from breastfeeding.

The insurer will pay suppliers about 45 percent less for each pump, dropping from $169 to $95, starting April 1. Customers were not notified of the change, which affects Virginia and 14 other states.

Anthem spokesman Scott Golden said in an email the decision "will not impact the ability of any new mother to access a high-quality, standard double electric breast pump from our nationally contracted medical suppliers." Company officials declined to be interviewed.

But breastfeeding advocates and medical professionals worry the change could lead women to give up breastfeeding in a society that can already make it a difficult practice to sustain, especially if their electric pumps' motors break down or if better pumps must be bought out of pocket.

"The people it affects are the mother and the baby," said Marsha Walker, a nurse and board-certified international lactation consultant based in Massachusetts. "That's someone's health for the rest of their life. That concerns me greatly."

The government started requiring insurers to provide one breast pump at no additional cost to new mothers in 2010 under the Affordable Care Act.

The legislation "may have helped more women in the United States breastfeed as a result," according to a Reuters article citing a 2017 study published in the American Journal of Public Health. There was an 11-fold increase in claims for breast pumps by women with private insurance in one state studied.

Some health insurers reimburse patients for the pumps directly. Under Anthem, at least locally, women choose a pump from a small selection provided by a supplier.

Anthem plans to cut the maximum amount it reimburses that supplier to $95. It's not the retail price. Suppliers can then negotiate with pump manufacturers such as Medela, Ameda and Spectra.

In a letter responding to advocates' concerns, Karen Shea, Anthem's staff vice president of maternal child services, said those suppliers "may be able to contract with the manufacturer for that piece of equipment at a much lower price."

But Dr. Jenny Thomas, a pediatrician and breastfeeding medicine specialist in Wisconsin -- one of the states affected by Anthem's cut -- said that's "naive." She said she's heard from some suppliers that they will not be able to negotiate pumps cheap enough from the industry-leading brands under the new cut.

"They're not going to be available at that price point," Thomas said. "There are real consequences to this."

Several medical equipment suppliers that work with Anthem did not return requests for comment.

Dr. Natasha Sriraman, associate professor of pediatrics at Children's Hospital of The King's Daughters and Eastern Virginia Medical School, said a good pump usually runs at least $150 to $200.

Any cut to breast pumps will hurt low-income households and working families the most, she said.

"In the end it's going to affect many women, but I think you have to look at our most vulnerable population," Sriraman said. "There's already so many barriers (to breastfeeding) as it is."

The American Academy of Pediatrics recommends exclusively breastfeeding for the first six months of a baby's life, followed by breastfeeding combined with other foods for the rest of the baby's first year. The practice protects against childhood obesity, respiratory tract infections, bacteria in the blood and diabetes, according to the academy.

But about 60 percent of mothers don't breastfeed for as long as they intend to, according to the Centers for Disease Control and Prevention. That's due to issues with babies latching, concerns about infant weight, unsupportive work policies or lack of parental leave and cultural norms, among other things, the CDC says.

Amanda Hockensmith, a breastfeeding counselor with Breastfeeding USA's Tidewater chapter, said it's especially important for working mothers to have effective breast pumps.

Hockensmith, who has a 3-year-old and a 7-month-old and works as a science teacher at Norfolk Public Schools, said trying to pump during breaks from work is already tough enough.

She'll usually get about 15 minutes to pump at work, "if I'm lucky. Time is something else against me in this breastfeeding relationship."

Factor in a pump with a faulty motor that works much more slowly, or runs down after just a few months, and an exhausted mother can easily give up breastfeeding, Hockensmith said. It "starts this vicious cycle of needing to repurchase or get parts for a subpar pump. You do get what you pay for.

"This is a new facet that people who give breastfeeding support will have to consider."

Advocates also argue avoiding health risks by breastfeeding ultimately saves insurers more money than cuts to equipment.

"It's very shortsighted on an insurance company's part," Sriraman said. "This is preventive medicine. ... It's interesting to me as a pediatrician and mother that you're cutting off what's essential for mothers and babies at the beginning of their life."

A pediatric cost analysis by Harvard researchers concluded that if 90 percent of families could comply with guidelines to breastfeed for six months, the United States would save $13 billion a year and prevent hundreds of infant deaths.

Breastfeeding "is not where you save money. This isn't a line item on your budget," Thomas said. "These are real people who need real support. If the insurance company doesn't provide that, there's a ripple effect of consequences."

L. Kathryn Norman, vice president of provider solutions at Anthem, said in an email to Thomas the decision "followed extensive analysis and review of market dynamics."

"Quality, accessibility and affordability were important components in making this decision to ensure Anthem's members will continue to receive high quality, affordable care. With that in mind and high confidence that quality affordable care remains intact, we respectfully decline the request that Anthem reverse" the decision.

Anthem spokesman Golden said in an email the insurer "recognizes the positive health benefits that breastfeeding can have on mothers and their newborns."

The company works with contracted suppliers to "make sure they have access to high-quality (pumps) that are also affordable," he said.

At least 580,000 people in Virginia were covered by private Anthem health plans in 2016, the last year for which data are available, according to the State Corporation Commission.

Walker, who serves on the U.S. Lactation Consultant Association's licensure and reimbursement committee, said threatening the quality of breast pumps affects mothers' and babies' health in the long run.

"My concern is that mothers are going to receive pumps that are not effective for what they need," she said. "That puts her milk production at risk and then the baby at risk. ... We keep telling mothers to breastfeed and then make it harder for them to do so."

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