Stakeholders expand coverage for ostomy supplies

MINNEAPOLIS – A group of stakeholders that includes Coloplast has now succeeded in expanding coverage for ostomy supplies in 11 states. 

Most recently, state Medicaid programs in three states have expanded coverage for ostomy supplies by increasing the number of codes they will reimburse: New Jersey (42 codes), Alabama (24 codes) and Georgia (16 codes). 

“While gaps in coverage still exist in these states, this is significant progress for individuals with Medicaid,” said Kathryn Vaughn, PT, DPT, director of market access for chronic care for Coloplast. 

A Market Access Team at Coloplast analyzed each state’s Medicaid fee schedule and/or provider manual to come up with a list of 17 states with limited coverage. 

The team then initiated partnerships with HME state and regional associations, the Wound, Ostomy and Continence Society (WOCN Society) and United Ostomy Associations of America (UOAA) to get a better understanding of how limited coverage was impacting providers, clinicians and Medicaid beneficiaries. 

“We heard that access to extend wear products was particularly challenging in these states and that health outcomes were poor, as a result,” Vaughn said. “We also focused on where the quantity of products allowed per month presented a challenge for ostomates.” 

Together, stakeholders worked to elevate these perspectives to the state Medicaid programs. 

“We have an excellent relationship with the Alabama Medicaid Agency,” said Michael Hamilton, executive director of the Alabama Durable Medical Equipment Association (ADMEA). “In fact, we have a DME Advisory Committee that meets with them quarterly. So, we passed along the request. We put it on the agenda for a meeting, along with other things we were working on, and it was a win. The people at the agency we work with regularly, who participate in these meetings, they’re all concerned about taking care of patients.” 

While it continues to work on expanding coverage for ostomy supplies, the Market Access Team has also performed a similar analysis of coverage and reimbursement for intermittent catheters and is in the process of gathering support in states where it has identified challenges. 

“We have already seen success, as New York Medicaid increased reimbursement for intermittent catheters on April 1,” Vaughn said.