Mail-order changes a ‘good first step’

Friday, March 9, 2018

WASHINGTON – Requiring CMS to enforce its own rules for the mail-order diabetes program will help to preserve beneficiary choice, say stakeholders.

“This certainly a good first step in trying to rectify a bad program,” said Kurt Anderson, director of advocacy for the American Association of Diabetes Educators. “There were some loopholes in the law that suppliers took advantage of.”

The budget for the Department of Health and Human Services for fiscal year 2019 included two provisions. The first would strengthen the 50% rule, by requiring, among other things, that bidders attest to their ability to maintain an inventory of strips consistent with their bid, and requiring CMS to establish and maintain a surveillance program to ensure suppliers are complying with the rule.

The second provision would codify the anti-switching rule, requiring suppliers to, among other things, verbally inform beneficiaries of their right not to be incentivized to switch brands of testing supplies.

Although both rules were implemented several years ago, surveys by the AADE have found that they’re not being enforced, says Anderson.

“Legislators don’t like it when they pass laws and then the body or agency doesn’t do a very good job of enforcing it,” he said. “It’s the will of Congress that this issue be taken care of.”

Now the AADE plans to conduct a member survey to assess what impact, if any, the closure of Arriva Medical has had on beneficiary access. The largest provider of mail-order diabetes supplies closed its doors in December, after losing an appeal to reinstate its Medicare billing privileges. Arriva serviced 450,000 Medicare beneficiaries in 2016, according to the HME Databank.

“Are those people going to other suppliers?” said Anderson. “Are they getting what they need? I can’t imagine a program that is already struggling, and you’ve got a major supplier that goes out of business—I can’t imagine that it’s going to be good.”


This article is 100% one sided and good luck with the enforcement. More rules and regulations dont solve the problem.
For one let’s remember who funds and sponsors the ADA and AADE programs, ah that’s right the largest brand manufacturers of supplies. Therefore what has occurred yet again is big Pharma spending millions to push a product to the stakeholder community and then being served a cold dish of revenge when their pricing and rebate model blows up. Simply put go back to the days of 2008 when Kerry Weems, then acting directory of the Medicare program testified in front of the House ways and means committee that diabetes strips were overpriced. When CMS set the stage for strip pricing to come way down, it was a race to the bottom. You will never be able to mandate that suppliers provide a product that is priced well above the single payment amount. The kicking and yelling is happening because Lifescan (J&J) signed EXCLUSIVE deals with a Arriva Medical to provide their patients a majority percentage of One Touch product. This is the main cause of the problem by landlocking deals. When the inevitable happens and a provider lost its billing privledges, no one else could provide the patient with One touch products. Medicare scrambled to advise patients to go to their local pharmacy. NEWS FLASH - CVS and Walgreens have no interest in providing a pharmacy retail box of diabetic testing strips (the likes of which cost $80 per box /50) to a plan paying $8.32 with copay collected. This ruling is yet another example of a paper tiger. It will create more confusion among the beneficiary and their is not one piece of evidence that FDA approved glucose meters are more accurate from one brand to the next. It is a farse peddled from big Pharma who have tied up millions in pushing sales reps to doctors offices to sell their product. Get the facts HME news before publishing these one sided stories. You can’t enforce a 50% rule when big Pharma refuses to price their product in accordance with bid prices.

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