Mystery surrounds nat’l mail-order program for diabetes testing supplies

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Friday, March 29, 2019

WASHINGTON – With the national mail-order program for diabetes testing supplies on hold indefinitely, it’s anybody’s guess what will happen next.

“We were all expecting another round—we still are,” said Mary Ellen Conway, chief compliance officer for Doral, Fla.-based US Med, one of nine companies holding a mail-order contract that expired Dec. 31, 2018. “We make the program work. The reimbursements are lousy, but there’s strength in numbers.”

CMS on March 7 announced plans for Round 2021, but for diabetes testing supplies, it said it needed additional time to implement changes mandated by the Balanced Budget Act of 2018. Among those changes: strengthening the 50% rule and codifying the anti-switching rule.

Even with those changes, consultant Tom Milam is concerned.

“Will there be real improvement to the program?” he said. “Access continues to be a problem and utilization likely continues to drop, and that doesn’t support better outcomes.”

While the current two-year gap in the bid program means all Medicare-enrolled providers can now serve beneficiaries, that’s unlikely to play out for diabetes testing supplies, which saw reimbursement reduced by about 71%. A box of 50 strips is currently reimbursed at $8.53.

“There’s not a lot of people hopping in at these price points,” said Stephanie Legree, Medicare billing manager for Center Line, Mich.-based Binson’s Home Health Care, another contract supplier.

As such, Legree is hopeful that the next round of the mail-order program will lead to higher reimbursement.

“It’s very difficult to provide what these beneficiaries want,” she said. “They know what there is and they want what the doctor tells them. It would be better to get higher reimbursement to provide a better array of the products they want to see.”

When CMS, ultimately, decides to announce the next round of the mail-order program, US Med will be ready, Conway says. It has the infrastructure and a business model already in place to serve beneficiaries via mail-order, she says.

“We don’t need two years to do a bid, so I think it could still happen for 2021,” she said.