Public Payers News

Medicare Limitations on Diabetes Supplies Endanger Patients

The Medicare Competitive Bidding Program presents patient safety risks by limiting diabetes testing supply choices, a new survey contends.

Medicare Competitive Bidding Program limits Diabetic Supplies

Source: Thinkstock

By Thomas Beaton

- Medicare’s Competitive Bidding Program (CBP) may increase the risk of negative patient safety events or medication nonadherence for diabetics by limiting the variety of available diabetes testing supplies, finds a survey by the American Association of Diabetes Educators (AADE).

According to the AADE’s research, the number of manufacturers making diabetes testing supplies (DTS) available under the National Mail Order (NMO) system has fallen by 50 percent since the CPB’s start in 2009, limiting providers’ ability to match patients with the best equipment for their needs.

Over 65 DTS brands once offered through the NMO are now unavailable. The number of DTS manufacturers offered to Medicare beneficiaries has fallen from 38 to 20.

“Physicians, diabetes educators and other healthcare practitioners often prescribe specific DTS based on the needs of individual patients, along with their experiences with the reliability, performance and features of specific products,” the researchers said.

“For example, some beneficiaries need audible readings or large displays because of poor vision. Providers may recommend DTS that are compatible with their office-based electronic medical record system. Different DTS are not interchangeable.”

The inability to provide certain brands under Medicare coverage options may increase the risk of diabetes complications, including blindness.  Limited options could also push beneficiaries into paying higher costs.  

“When a beneficiary is forced to use a DTS that is unknown, difficult, confusing, or unreliable, adherence to testing may diminish, increasing the risk of complications, which can be costly for Medicare and its beneficiaries,” the team said.

Another major problem for beneficiaries is that when asked, DTS suppliers within the CPB provided inconsistent inventories to beneficiaries 100 percent of the time.

The Medicare statute requires that potential bidders for mail-order DTS (CPB participation) must to cover 50 percent of the DTS market.  However, AADE points out that there is no requirement to remain at 50 percent coverage after a bidder is accepted into the CPB.

“In other words, while a supplier is required to submit a bid based on the specific brands and models it may intend to make available, the supplier is not obligated to make available the range of products identified in its bid once it gets a contract from CMS,” AADE said. 

Sampled Market Share Among DTS Suppliers

Source: AADE

When the AADE compared market shares of 11 DTS suppliers, they found that 5 of them had hit the 50 percent benchmark initially required by CMS. One supplier was found to only carry one type of DTS that is used by less than one percent of the entire DTS market.

“Although Congress clearly intended the 50 percent rule to ensure that beneficiaries would have access to the DTS offered before the NMO program, the reality is that beneficiaries do not have access to familiar and preferred DTS,” the team said.

Based on the survey results, the AADE suggests that CMS needs to strengthen its beneficiary protection requirements in the next round of CBP bidding.

AADE suggests making it a strict condition that bidders provide beneficiaries the same DTS brands and models in their original bids, meeting the 50 percent rule.

CMS should also regularly audit competitive bidding suppliers to ensure they meet compliance and quality standards, according to AADE. To supplement this process, AADE says a corrective action plan administered by CMS should manage bidders who fail to adhere to regulatory requirements, and would remove suppliers that continually violate programmatic rules.