ADS takes on burden for pharmacies

CARLSBAD, Calif. – Advanced Diabetes Supply recently expanded its Part B services to retail pharmacies to include management of diabetes supplies.  

The move made sense for ADS, which has already been partnering with pharmacies to offer continuous glucose monitors, says CEO Bill Mixon. 

“CGM is central to what we do, but we provide other diabetes testing supplies that these patients might need,” he said. “We can fulfill those through the DME benefit, which is difficult for the pharmacy to handle well.” 

To make it all work, ADS connects with the pharmacy’s workflow systems and contacts patients within 24 hours to “take over” management of CGMs and other diabetes supplies. The company educates and trains, communicates about refills, obtains prescriptions and necessary documentation, and collects reimbursement. 

With about 80% of CGM medical records and prior authorizations at least one component shy of meeting requirements, ADS’s expertise in Part B billing is key to pharmacies, says Mixon. 

“Pharmacies tend to be oriented around high-volume prescriptions,” he said. “We, as a CGM DME provider, have a much more hands-on approach, where we work with the patient to make sure they are using the technology to drive better health outcomes and allow the pharmacy to focus on other business.” 

Since initially partnering with pharmacies to offer CGMs in 2020, ADS has contracted with Medicare and more than 500 private insurers, serving more than 60,000 patients on behalf of about 12,500 national and regional pharmacies. 

A patient re-order rate of 96% points to how well the program works for pharmacies and patients, say Mixon. 

“The pharmacy’s patients have a great patient experience, and it leads to ongoing retention for the pharmacy,” he said. “We’re very focused on education and being a resource for the patient.” 

• Bill Mixon made the leap from wheelchairs to diabetes supplies in 2023.