NCPA Warns New Policy Could Cause Independent Community Pharmacies to Stop Selling Diabetes Testing Supplies Due to Low Reimbursement

Published Online: Thursday, August 2, 2012
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Alexandria, Va. - July 23, 2012 Today Bill Popomaronis, RPh, National Community Pharmacists Association (NCPA) Vice President of LTC / HHC /NIPCO, testified at a public meeting held by the U.S. Centers for Medicare and Medicaid Services (CMS) regarding the potential reduction in payments for diabetes supplies using the "inherent reasonableness" standard to the Medicare fee schedule amounts for non-mail order diabetes testing supplies. He warned the policy would produce financially unsustainable reimbursement cuts for independent community pharmacies that sell these valuable medical products that help ascertain blood glucose levels.

"Community pharmacists are indispensable to helping combat diabetes, whether it is the counseling they offer, the medications they dispense, the lifestyle modification classes they provide, or the wide variety of testing supplies they carry," said Popomaronis. "However, that dynamic will be harmed if these small business pharmacies are forced to walk away from a pricing structure for diabetic testing supplies that only a large self-warehousing chain pharmacy or mail order supplier can make work."

The policy comes on the heels of other impediments to selling diabetes testing supplies under Medicare Part B, as CMS has proposed burdensome and expensive requirements, while working with a secondary payer to receive slow reimbursements. In his testimony Popomaronis detailed the concerns that come with the "inherent reasonableness" standard, which include:
  • Reimbursement reductions that are financially unsustainable because small pharmacies cannot purchase the supplies in bulk like the large chains or mail order suppliers;
  • A lack of evidence that the fee schedule is grossly excessive as compared to the cost to independent pharmacies to purchase these supplies;
  • The misguided notion by CMS that savings and success for diabetic patients necessarily means driving down per unit costs, which may be contrary to the integrated care models being promoted by health care systems in the public and private sector; and
  • A failure to acknowledge the money CMS wastes on mail order diabetes testing supplies that are shipped, as demonstrated by the large amount of waste generated by mail order supplies in the One Year Implementation Update to Round 1, and further confirmed by CMS' own Jonathan Blum who suggested the competitive bidding program decrease in utilization of mail order diabetes testing supplies could lead one to infer that community pharmacies could serve patients better than mail order.
Popomaronis added, "Independent community pharmacists are working hard to provide the best care and access to beneficiaries while working with CMS to improve quality of care and drive down long-term costs. The facts are, with drastic cuts to reimbursement for diabetic testing supplies, beneficiaries will no longer have access to the care they need and deserve."


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