On July 1, Medicare established the Medicare National Mail-Order program, which drastically decreased the price of blood glucose testing supplies for people on Medicare, but requires people to get their supplies, including blood glucose trips, lancets, lancet devices, batteries and control solution, from a selection of 18 designated suppliers. These 18 companies were selected through a competitive bidding program.
It is quite likely that the new regulations will reduce out-of-pocket expenses for many people. But some at Joslin have raised concerns that the changes will create obstacles that will result in people reducing the number of times they test each day – which in turn will have a huge impact on their diabetes control.
To start with, many older people with diabetes are comfortable with their current meter, and according to Bridget Stewart, Vice President of Clinical Operations at Joslin, if forced to change their meter, they may not test their blood glucose levels as frequently.
“My biggest concern would be making sure that patients can get the supplies that they need, when they need them,” said Stewart. “[These changes] could result in patients becoming frustrated with the system, which could result in them testing less frequently, or not at all. [This] could lead to hospitalization or other potentially life threatening situations, and that’s what we are really concerned about [at Joslin].”
Agreeing with Stewart, Cathy Carver , M.S., A.N.P., C.D.E., Vice President for Advocacy and Planning at Joslin, stressed that patients who test their blood glucose levels more frequently are more likely to see better outcomes.
“We are worried [because] some patients actually like and use the meter they have, and if it’s going to cost them $50 for a container of strips – out of pocket [costs] for them – it’s not likely they are going to pay that,” commented Carver. “Our worry is that they are going to stop testing, and we know that patients that test tend to do better.”
According to Carver, another challenge generated by these changes is that some suppliers, like Neighborhood Diabetes, stated they will no longer honor Medicare once these changes go into effect, meaning that people who purchase their strips from them will have to find an alternative option.
For people who receive their testing supplies from a local pharmacy, they are still able to do so, but they need to make sure that the store accepts Medicare “assignment” to avoid higher charges for their supplies.
An additional concern, also highlighted by Carver, is that for every three months Medicare may only cover 100 strips and 100 lancets for people who do not use insulin. For people who do use insulin, Medicare may cover only 300 strips and 300 lancets for every three months. People who use insulin and test their blood glucose levels more than three times a day will have to use out-of-pocket funds to cover the additional strips.
Aside from increased out-of-pocket expenses, there are other financial changes from the new Medicare program. Prior to July 1, companies billed Medicare for blood glucose testing supplies that they distributed to people with diabetes. According to Krista Maier, the Associate Director, Public Policy at American Diabetes Association, Medicare paid approximately $78 for 100 test strips and lancets. This equals one month’s supply of strips for someone who checks their blood glucose three times a day.
Now with the new program, Medicare cut their reimbursement payments to approximately $22. This change also affects patient copays, which dropped from $15 to less than $5. Over the next decade, this program is predicted to save taxpayers $26 billion by enacting stricter guidelines on waste and fraud in the medical equipment sector.
Although Medicare is in favor of these new changes, Joslin is less worried about the financial implications of these changes, and more concerned with how their patients will be affected.
“Well Medicare in its effort to bend the cost curve and eliminate waste has reduced the reimbursement to [approximately] $22.43, so that pretty much puts all the big companies out of business in terms of blood glucose monitoring,” explained Carver. “[But] what I’m worried about is that this [new program] will disrupt the supply of strips to our patients.”
In response to the National Mail-Order Program, Joslin physicians have written to insurance companies on behalf of their patients to lobby for their patients to remain on the meters that they are most comfortable with.
For more information regarding Medicare’s the new changes and how to navigate the new rules, please refer to Carver’s detailed explanations: Alleviating the Confusion over New Changes around Diabetes Supplies.