Mail-order changes a ‘good first step’

Friday, March 9, 2018

WASHINGTON – Requiring CMS to enforce its own rules for the mail-order diabetes program will help to preserve beneficiary choice, say stakeholders.

“This certainly a good first step in trying to rectify a bad program,” said Kurt Anderson, director of advocacy for the American Association of Diabetes Educators. “There were some loopholes in the law that suppliers took advantage of.”

The budget for the Department of Health and Human Services for fiscal year 2019 included two provisions. The first would strengthen the 50% rule, by requiring, among other things, that bidders attest to their ability to maintain an inventory of strips consistent with their bid, and requiring CMS to establish and maintain a surveillance program to ensure suppliers are complying with the rule.

The second provision would codify the anti-switching rule, requiring suppliers to, among other things, verbally inform beneficiaries of their right not to be incentivized to switch brands of testing supplies.

Although both rules were implemented several years ago, surveys by the AADE have found that they’re not being enforced, says Anderson.

“Legislators don’t like it when they pass laws and then the body or agency doesn’t do a very good job of enforcing it,” he said. “It’s the will of Congress that this issue be taken care of.”

Now the AADE plans to conduct a member survey to assess what impact, if any, the closure of Arriva Medical has had on beneficiary access. The largest provider of mail-order diabetes supplies closed its doors in December, after losing an appeal to reinstate its Medicare billing privileges. Arriva serviced 450,000 Medicare beneficiaries in 2016, according to the HME Databank.

“Are those people going to other suppliers?” said Anderson. “Are they getting what they need? I can’t imagine a program that is already struggling, and you’ve got a major supplier that goes out of business—I can’t imagine that it’s going to be good.”