In brief: Diabetes drugs, catheter investigation, Henry Schein reorg, CHME Pharmacy

WASHINGTON – Medicare Part D spending for 10 selected diabetes drugs totaled more than $35.8 billion in 2023, a 364% increase from 2019, according to a new data brief from the Department of Health and Human Services Office of Inspector General. 

Meanwhile, the number of Medicare Part D enrollees increased from 44.9 million to 50.5 million, a 12% increase. 

“Certain diabetes drugs initially approved by the Food and Drug Administration to help control blood sugar levels for individuals with Type 2 diabetes are known to be effective weight loss agents,” the brief states. “Prescriptions for and spending on diabetes drugs increased substantially in the last five years. Medicare Part D covers diabetes drugs for FDA-approved indications such as Type 2 diabetes or cardiovascular disease, or if that coverage is offered as an enhanced Part D benefit, but it does not cover drugs prescribed for weight loss.” 

Medicare Part D spending for Ozempic, specifically, increased from $552 million to $9.2 billion, a 1,568% increase, while the number of enrollees filling a prescription for the drug increased from 142,479 to 1,465,482, a 929% increase. 

Projected Medicare Part D spending for the selected diabetes drugs could reach $102 billion by 2026, according to the data brief. 

“This substantial increase could have a financial impact on the Medicare program,” the brief states. “Information in this data brief may be beneficial to CMS and other policymakers when developing future program guidance related to these drugs.” 

• Related: FDA approves GLP-1 for OSA. 

AdaptHealth says it continues to make progress 

PLYMOUTH MEETING, Pa. - AdaptHealth has reported net revenue of $856.6 million for the fourth quarter of 2024, a 0.2% decrease compared to the same period in 2023, and $3.26 billion for the full year 2024, a 1.9% increase compared to 2023. 

Net income was $50.3 million vs. a net loss of $254.5 million for the quarter and $90.4 million vs. a net loss of $678.9 million for the year. 

“Over the course of the second half of 2024, we continued to make progress on our five areas of focus, which include our One Adapt initiative, accelerating the application of AI and automation, increasing our clinical relevance, delivering organic growth and strengthening our balance sheet,” said Suzanne Foster, CEO. “The progress we have made helped drive our solid fourth quarter results and, more importantly, is strengthening our foundation for long-term success and growth.” 

AdaptHealth reported adjusted EBITDA of $200.6 million for the quarter, a 2% decrease, and $688.7 million for the year, a 2.7% increase. 

For fiscal year 2025, the company expects net revenue of $3.22 billion to $3.36 billion; adjusted EBITDA of $670 million to $710 million; and free cash flow of $180 million to $220 million. 

CHME provides ‘seamless access’ with new pharmacy 

FOSTER CITY, Calif. - CHME has opened CHME Pharmacy LLC, an independent pharmacy in Foster City, Calif., in a move that the company says expands its commitment to comprehensive health care solutions for Bay Area residents. 

The partnership brings together CHME’s established medical equipment expertise with a full-service, independently owned pharmacy offering personalized care and free delivery. 

"We're excited to expand our health care services with the addition of CHME Pharmacy LLC, bringing back the personal touch of a local independent pharmacy," said Bernie Zimmer, CEO. "Our vision is to provide seamless access to both medical equipment and pharmacy services, creating a more convenient and comprehensive health care experience for our community." 

CHME says CHME Pharmacy distinguishes itself by offering: 

• personalized medication management and counseling 
• comprehensive prescription services for both families and their pets 
• one-on-one consultations with experienced pharmacists 
• convenient appointment-based care to eliminate wait times 
• point-of-care testing 
• on-site vaccinations and immunizations clinics for community groups and businesses 
• free delivery services available on request 
• long-term care services with compliance packaging 

CHME currently serves San Francisco, Alameda, San Mateo, Santa Clara, San Jose, Contra Costa, Santa Cruz and North Bay counties. 

OIG investigates catheter billing 

WASHINGTON – The Office of Inspector General estimates that Medicare improperly paid $35.1 million for catheters and kits from July 2021 through July 2022. 

The agency paid a total of $303.3 million for catheters and kits during that time period. 

The OIG found that: 

• Payments for 88 of 105 sample items met requirements. (It did not review 2 of 105 sample items and treated them as non-errors because after it had selected its sample, we determined that Medicare contractors had denied the claims.) 
• Payments for the remaining 15 sample items did not meet requirements. Specifically, medical records did not support eligibility for curved-tip catheters or sterile catheter kits, or suppliers did not meet Medicare requirements for catheter refills, proof of delivery, or a standard written order. 

The OIG also found that suppliers billed 125,426 claims for curved-tip catheters to female Medicare beneficiaries in 2023 compared to 2,753 from July 2021 through July 2022. 

“This large increase in claims billed may be an indication of improper claims,” the OIG stated. “We shared our analysis, identifying suppliers with questionable billing patterns, with CMS so that it could take action as needed. In comments on our draft report, CMS informed us that it had already taken corrective action on 15 suppliers.” 

The agency recommends that CMS: 

• Instruct Medicare contractors to recover $11,399 in overpayments made to suppliers for the 15 sample items that did not meet Medicare requirements; 
• Perform additional medical reviews of claims for catheters and kits, which could have saved Medicare an estimated $35.1 million for our audit period; and 
• Provide additional education to suppliers on documenting eligibility for curved-tip catheters and kits and on documenting refills of catheters and kits. The full recommendations are in the report. 

CMS concurred with all the OIG’s recommendations except one related to the 60-day-rule requirements for suppliers. The OIG removed that recommendation. 

Read the OIG’s full report here.  

Henry Schein implements new org structure  

MELVILLE, N.Y. - Henry Schein has simplified its organizational structure and appointed Andrea Albertini and Tom Popeck to lead its three business groups as part of its 2025 to 2027 BOLD+1 Strategic Plan. Albertini will be responsible for Global Distribution and Value-Added Services Group and the Global Technology Group, and Popeck will be responsible for the Global Specialty Products Group. Albertini, who joined Henry Schein in 2013 and most recently served as president of the company’s International Distribution Group, has more than 20 years of experience in senior leadership positions in the health care products and services industry. Popeck, who joined Henry Schein in 2019 and most recently served as president of the Henry Schein Healthcare Specialties Group, has more than two decades of experience leading businesses in orthopedics and industrial manufacturing. The Global Specialty Products Group, which includes orthopedic products and other health care-related products and services, had annual sales of $1.4 billion for full year 2024. The reorganization was announced as part of the company’s fourth quarter and full-year 2024 financial results. Henry Schein reported total net sales of $3.2 billion for the fourth quarter, a 5.8% increase compared to the same period in 2023, and $12.7 billion for full-year 2024, a 2.7% increase compared to 2023. For 2025, the company expects total sales growth of 2% to 4%. 

Lofta, PMTA partner for trucking safety 

SAN DIEGO – Lofta has announced a strategic partnership with the Pennsylvania Motor Truck Association to increase access to streamlined at-home sleep apnea testing and treatment for trucking professionals. Through the partnership, PMTA members will benefit from Lofta Direct’s comprehensive at-home sleep apnea program, which provides fast, accurate diagnoses without the need to visit an overnight lab. Lofta will also provide ongoing CPAP therapy support for diagnosed drivers and ensure compliance with federal regulations, including the need to renew medical cards as a commercial driver. “We are excited to have Lofta supporting the association,” said Megan Magensky, director of communications for PMTA. “Their platform is focused on prioritizing driver health and safety, which aligns with PMTA’s mission.” As part of the partnership, Lofta Direct will offer a dedicated landing page for PMTA members, with easy access to Lofta's resources. Lofta Direct and PMTA will also collaborate on educational email campaigns and a health seminar to raise awareness about the importance of sleep health in trucking safety. 

Allied Health Solutions rebrands to WVU Medicine HME 

MORGANTOWN, W. Va. - Allied Health Solutions Durable Medical Equipment has rebranded to WVU Medicine Home Medical Equipment. “WVU Medicine Home Medical Equipment, formerly known as Allied Health Solutions Durable Medical Equipment, may have officially transitioned to the WVU Medicine brand at the beginning of the year, but the enterprise remains dedicated to providing top-quality products and exceptional, compassionate customer service to patients throughout West Virginia and surrounding states,” said Maggie Thieman, M.D., WVU Health System vice president of post-acute services. “The connection to WVU Medicine allows the team to provide a comprehensive HME selection with direct ties to world-class medicine and continuity of care.” The West Virginia University Health System, the state’s largest system and largest private employer, is comprised of 25 hospitals, including its flagship J.W. Ruby Memorial Hospital in Morgantown. HME is committed to delivering affordable, high-quality products and equipment, including orthopedic bracing, CPAP machines, accessible rental home care beds, canes, mobility aids for musculoskeletal recovery, ventilators for patients with chronic obstructive pulmonary disease (COPD) and more to ensure a seamless transition of patient care to the home. WVU Medicine Home Medical Equipment stores are conveniently located in Bridgeport, Kearneysville and Morgantown.  

NYC Care partners with AdaptHealth to increase access to DME 

NEW YORK – NYC Health + Hospitals’ NYC Care program has launched a DME benefit available at all NYC Health + Hospitals facilities supported by exclusive partner AdaptHealth. Patients without traditional medical insurance previously had to purchase any prescribed DME out-of-pocket. “The launch of the durable medical equipment benefit for eligible NYC Care members is an important milestone for the program as we continue to eliminate barriers to health care for New Yorkers,” said Jonathan Jiménez, MD, MPH, executive director of NYC Care from NYC Health + Hospitals. “From wheelchairs to continuous glucose monitors to CPAP machines, eligible members can now obtain the durable medical equipment their ambulatory care provider prescribes – thanks to our partnership with AdaptHealth." The launch of the benefit follows a pilot program at the Safey Net clinics at NYC Health + Hospitals/Bellevue and Woodhull that resulted in 746 unique DME orders for 136 patients, with the most commonly ordered DME being CPAP machines and associated accessories, diabetes-related supplies, mobility devices and urinary supplies. NYC Care has grown to more than140,000 active members and has provided more than 1 million primary care appointments for its members. Since launching in 2019, it has provided hundreds of thousands of specialty care appointments, including 365,226 women’s health appointments, 284,766 eye care appointments and 187,425 behavioral health appointments. NYC Care’s community-based organization partners have reached more than 1 million New Yorkers, scheduled more than 43,000 enrollment appointments and facilitated more than 17,000 direct enrollments. 

Motion continues Rehab Expo 

TORONTO – Motion has announced the return of its Motion Rehab Expo with 11 events scheduled across Alberta, British Columbia, Manitoba, Ontario and Saskatchewan in 2025. It’s the first time the company will hold an expo in Saskatchewan. Motion has also released a promotional video to showcase the expo, which comprises a complimentary full-day of education and networking event with presentations by leading health care professionals and equipment suppliers.  This year marks the company’s 40th year of operations, a milestone it is commemorating with the tagline “40 Years of Caring.” Register for the expo here. 

PranaQ set to launch TipTraQ nationwide 

NEW YORK – PranaQ has received 510(k) clearance from the U.S. Food and Drug Administration for TipTraQ, a single point of contact home sleep apnea test wearable that it says provides sleep and respiratory insights with minimal disruption. With this clearance, PranaQ is set to launch TipTraQ nationwide to sleep clinics, telehealth providers and hospitals. "Receiving FDA clearance for TipTraQ is a significant milestone in our mission to revolutionize sleep diagnostics and monitoring,” said Jerry Chen, CEO of PranaQ. "With millions of undiagnosed sleep apnea sufferers, TipTraQ enables accessible and reliable at-home testing, helping more people receive timely diagnosis and treatment." PranaQ says TipTraQ is a compact wearable that uses advanced biosensors and AI algorithms to detect sleep apnea events and analyze sleep architecture with clinical-grade accuracy. The device enables patients to undergo testing from the comfort of their homes, reducing barriers to diagnosis and improving patient compliance. In addition to its comprehensive sleep parameters, TipTraQ is cleared for its ability to identify sleep apnea severity cutoffs of 5 (mild), 15 (moderate) and 30 (severe) under both the AASM 1a and 1b rules, delivering actionable insights to support well-informed clinical decisions. 

Embla Medical names head of R&D 

REYKJAVIK, Iceland, and COPENHAGEN, Denmark – Embla Medical, a global provider of mobility solutions, has announced that André Rocha has been appointed executive vice president of research and development. Rocha has served as partner at global management consulting firm McKinsey & Company for the last 13 years. “We are very excited to welcome André Rocha to Embla Medical,” said Sveinn Sölvason, Embla Medical president and CEO. “His vast experience in R&D, engineering and product development make him well-suited to lead our innovation efforts and contribute to developing advanced solutions for people with mobility challenges.” Rocha’s career also includes several R&D roles at Nokia (formerly Nokia Siemens Networks). Over his 25-year career, he has led teams across a wide range of geographies and cultures, including the Nordics, Iberia, Germany, the U.S., India and Japan. 

Short takes, Medtrade edition: Stand Up for Homecare, Provider’s Choices 

AAHomecare’s Stand Up for Homecare reception at Medtrade raised $55,000 to advance the association’s efforts to support patient groups that serve HME provider customers and that support the industry’s policy priorities. That amount is about 10% more than was raised at last year’s event. “Thanks to our generous sponsors and attendees for helping bring HME leaders together and allowing us to further strengthen our relationships with patient advocacy partners and bring more resources to the fight for better DME policy,” the association stated in a press release... The Provider’s Choice Gold at Medtrade went to the Motif Aura Glow Wearable Breast Pump from Motif Medical. The Wrappon, a portable dry toilet that wraps and seals waste in public, from Wrappon USA earned Provider’s Choice Silver; and The Dashmoto, a three-wheeled seated power scooter, from dash 3 earned Provider’s Choice Bronze. The awards are sponsored by HomeCare Media.