Protecting Access to Diabetic Testing Supplies

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Pharmacy Times, March 2018 Central Nervous System, Volume 84, Issue 3

Proposed federal legislation aims to achieve better health outcomes by giving patients with diabetes the freedom to decide which testing supplies work best for them.

Nearly 26% of Medicare beneficiaries suffer from diabetes, according to the CDC.1 This chronic disease stems from impaired glucose control and requires frequent monitoring of blood glucose levels using glucometers, lancets, and test strips. Proposed federal legislation aims to achieve better health outcomes by giving patients with diabetes the freedom to decide which testing supplies work best for them.

That legislation was introduced in the US House of Representatives by Reps. Susan Brooks (R, IN), Diana DeGette (D, CO), and Tom Reed (R, NY). The Protecting Access to Diabetes Supplies Act (HR 3271) would help ensure that Medicare patients are able to receive their preferred diabetic testing supplies through the national mail order competitive bidding program (CBP).2 Medicare beneficiaries under Parts A and B are required to use a Medicare national mail-order contract supplier if they choose to receive diabetic testing supplies at home.3

The CBP was originally mandated by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to change the payment approach for durable medical equipment, orthotics, prostheses, and supplies.3 The mandate was designed to allow access to quality supplies and reduce beneficiary out-of-pocket expenses, as well as to save the Medicare program money. Suppliers who operate within a particular competitive bidding area electronically submit a bid to CMS, and contracts are created between suppliers and CMS. Patients who participate in mail order are required to use contract suppliers, or Medicare typically will not pay for durable medical equipment. Contract suppliers are not allowed to charge individuals more than the 20% coinsurance and any unmet yearly deductible for equipment within the program, but patients in most states were immediately affected by this legislation.4

Although the CBP was originally designed to develop a system in which patients would still have access to the blood glucose test systems of their choice, there have been deficiencies in the regulations established. To further strengthen mandated requirements and safeguard patient access, HR 3271 would require diabetes product suppliers to include at least 50% of the different types of test systems that were on the market before the CBP was implemented.2

Without the proposed legislation in place, if a patient needs a particular brand of testing supplies in order to prevent adverse outcomes, the doctor must specifically prescribe the requested brand and provide proper documentation undergirding that decision, with the hope that accommodations can be made. This often results in suppliers encouraging beneficiaries to switch from one testing system to another.

Implementation of this legislation may have profound effects on the increasing population affected by diabetes, as new projections predict that half of Americans older than 65 have prediabetes.1 Because the disease is lifelong and requires diligent monitoring, it is important that patients are equipped with the materials that allow them to best control the disease. This bipartisan bill is one that both Democrats and Republicans can fully support for the betterment of millions of Americans with diabetes.

Emma K. Turner is a PharmD candidate at the University of Kentucky College of Pharmacy in Lexington.

Joseph L. Fink III, BSPharm, JD, DSc (Hon), FAPhA, is a professor of pharmacy law and policy and the Kentucky Pharmacists Association Endowed Professor of Leadership at the University of Kentucky College of Pharmacy in Lexington.

References

  • Number of Americans with diabetes rises to nearly 26 million [news release]. Atlanta, GA: CDC; January 26, 2011. cdc.gov/media/releases/2011/p0126_diabetes.html. Accessed December 21, 2017.
  • Protecting Access to Diabetes Supplies Act of 2017, HR 3271, 115th Cong, 1st Sess (2017).
  • Competitive bidding program. Medicare.gov. medicare.gov/what-medicare-covers/part-b/competitive-bidding-program.html. Accessed December 21, 2017.
  • The competitive bidding demonstration. Medicare Interactive website. www.medicareinteractive.org/get-answers/medicare-covered-services/durable-medical-equipment-part-b/the-competitive-bidding-demonstration. Published 2017. Accessed December 21, 2017.