Seems like there's always some new roadblock cropping up to thwart us from getting the diabetes supplies we need…
The latest hurdle comes from the beleaguered Centers for Medicare & Medicaid Services (CMS). According to a new survey just released by the American Association of Diabetes Educators (AADE) on Feb. 3 -- surprise, surprise! -- CMS is now limiting patient access to insulin pumps as well as meters, strips and other basic supplies. The results are disturbing, and they add to the already dismal state of affairs at as it pertains to diabetes.
Remember that CMS introduced its controversial competitive-bidding process in 2013, requiring PWDs (people with diabetes) on Medicare to choose from an approved short-list of diabetes suppliers to get what they need to survive. First, this limited only glucose meters and strips by mail-order. And then the limits expanded to pharmacies.
We were worried, but were reassured by the government and CMS leaders that all would be OK. Yet an initial AADE survey from early 2014 found that the competitive-bidding process was failing PWDs on Medicare who needed mail-order testing supplies.
Because CMS is not properly monitoring the companies selected for the bidding process and “the agency has not taken action against suppliers who have changed their offerings since their bids were accepted,” they are getting away with offering customers the cheapest, lowest-quality glucose meters, according to testimony from AADE Chief Advocacy Officer Martha Rinker in the 2014 survey.
CMS recently announced inclusion of insulin pumps on the list of medical supplies going through competitive-bidding in nine regions across the country.
For the AADE survey conducted last Fall, educators across the country called up a total of 29 different supplies located in those nine cities, asking about specific insulin pump brands and models along with replacement supplies. Only 17 of them (58%) reported carrying insulin pumps at all, and just 18 (62%) reported carrying replacement supplies and reservoirs.
Equally concerning is that the AADE researchers found that many of the contract suppliers who do offer pumps and supplies do not offer more than one brand -- restricting access to choice for PWDs reliant on Medicare.
“These findings raise concerns with the prospect of expansion of competitive bidding for insulin pumps and supplies to areas outside of the original nine Competitive Bidding Areas,” says James Specker, director of the AADE's federal and state advocacy.
To address these issues, AADE is calling for two key steps to be taken:
- CMS should enforce the requirement that competitive bidding suppliers make available all Medicare-covered insulin pumps and replacement supplies, as indicated through the HCPCS (Healthcare Common Procedure Coding System) billing codes to increase the number of suppliers from which patients can obtain these items.
- Insulin pumps and related supplies should be removed from the current confusing and overly broad product category in which they are currently categorized (DME, or Durable Medical Equipment – which also includes oxygen tents, hospital beds and wheelchairs), and instead redefined as a new independent product category, “Continuous Insulin Infusion Systems and Supplies.” Redefining the product category would require winning suppliers to stock these items, and help ensure that patients gain access to the type of insulin pump that best serves them in managing their diabetes.
The AADE is calling for national policymakers to pay attention to this matter, since it has a potentially enormous budget impact (!) One out of three Medicare dollars is currently spent on diabetes, and a high percentage of overall health care spending is attributed to undermanaged or un-managed diabetes.
AADE Advocacy > Calling on the DOC
We wondered how AADE plans to move this forward on this, beyond issuing a press release to call attention to their findings within the Diabetes Community and beyond.
Here's a brief Q&A with Specker (pictured right), AADE's director of federal and state advocacy.
DM) What does AADE hope to achieve with these survey results?
JS) The findings will be used primarily with our communications with CMS and various Congressional committees of oversight so we can, hopefully, encourage changes to the CBP (competitive bidding program) regarding the availability of insulin pumps and related supplies for Medicare beneficiaries.
Has this information been shared with CMS yet?
We are in the process of scheduling meetings with CMS staff and will present these findings as soon as we can get in front of them. We may call on members of the DOC (Diabetes Online Community) to attend those meetings; I will know more on that in the next couple of days.
What about Congress... have these results been shared with any individual members or caucuses?
The results of the survey are being sent, electronically, to Members of Ways & Means, Energy & Commerce and the Senate Finance Committee. As a follow-up to that we are scheduling face-to-face meetings with committee leadership and, again, may need to call on members of the DOC to attend those meetings.
What responses have you received so far?
The survey launch is still in its infancy and we have just started our press media campaign, so outside of a few inquiries from our organizational partners who view this as a much-needed resource to encourage change we have not had any responses. That said, the survey we did on diabetes testing supplies in the CBP took a couple of weeks to get going but once it did we received quite a bit of interest from various media outlets as well as feedback from some of the contract suppliers.
Will there be any follow-up to ascertain what's changed or being done about this?
Yes, we will be staying with this issue all the way through the pilot round into the CBP re-compete (Round 2 of competitive bidding, open now through Feb.23, 2015).
What can we do, from the patient perspective in the Diabetes Community?
Right now I think covering this issue and getting it out to your audiences is a great first step. In the coming days I will be reaching out to the leaders of the DOC for a conference call to talk about an extended social media/media campaign.
This is a hugely important issue, especially since CMS is looking to expand this program in
to other areas of the country. We hope that AADE can help get this message out, and prompt government leaders to do better and make this system more reliable and accountable.
Right! And don't even get us started on CGM access for Medicare-covered people with diabetes... yeah, that needs attention too.