Options for Medicare Beneficiary with Diabetes?

Community pharmacists maintain one of every three Medicare Part B supplier billing numbers; thereby, providing easy access to necessary supplies for patients with diabetes. What if the number of DMEPOS pharmacy suppliers is reduced by 50 percent? That’s exactly what CMS expects with the implementation DMEPOS competitive bidding.

Even though there are more than 150,000 billing numbers out there, if you look at the supplier breakdown link on the DME Resource Center (http://www.pharmacistelink.com/medicaredme/nsc.asp), it is clear that without community pharmacists, access is severely restricted, unless you want to use mail order! (Hmm …never heard of that before).

One of the first questions I asked as a member of the PAOC was what affect did limiting access in the demonstration areas of Polk County and San Antonio have on shifting beneficiary DMEPOS expenses to the Medicare Part A benefit. I was particularly interested in diabetes testing supplies. CMS has their eye on that category as it represents 9.5 percent of all Medicare DMEPOS expenditures.

Incredibly, I was told this assessment was not part of the original plan design. Additionally, and much to my dismay, diabetes testing supplies were not even part of the original competitive bidding demonstration projects.

Respected 2006 studies shared with CMS indicate that if Hemoglobin A1c levels rise slightly in just 5 percent of beneficiaries with diabetes, then CMS should expect a 10 fold increase in Medicare Part A expenditures in the form of increased hospitalizations for diabetes related complications.

NCPA continues to petition CMS to exempt diabetes testing supplies from competitive bidding. At the very least, a demonstration project is warranted to assure that limiting diabetic testing supplies in community pharmacies will not trigger the cost shifting described. The jury is still out.

After all, I thought the number one reason for competitive bidding was to protect the beneficiary.

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