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Survey demonstrates that suppliers in Medicare's Competitive Bidding Program for Insulin Pumps are not Providing Products as Mandated by Law

Feb 03, 2015

A survey conducted by the American Association of Diabetes Educators (AADE) has found that suppliers selected to participate in Medicare’s competitive bidding program are failing to provide access to insulin pumps and related supplies.

“This failure to comply with the program results in limited access to necessary equipment for people with diabetes. With 1 in 3 Medicare dollars currently spent on diabetes, with a high percentage of spending attributable to unmanaged or undermanaged diabetes, this action has significant and dramatic ramifications for Medicare spending on diabetes as well as the health of patients who rely on insulin pumps to help manage their disease,” said James Specker, director of federal and state advocacy for AADE.

As mandated by Congress, the Centers for Medicare and Medicaid Services (CMS)  is in the process of implementing a competitive bidding program, with the goal of increasing efficiencies in the delivery of certain durable medical equipment and diabetes testing supplies to Medicare beneficiaries.  Insulin pumps are currently included in nine so-called ‘competitive bidding areas’ across the country, in which Medicare patients are required to obtain their insulin pumps from suppliers who are awarded contracts through the competitive bidding program.

AADE’s survey of those suppliers found a number of discrepancies between what the suppliers are required to offer to consumers, and what is happening in reality:

  • Many contract suppliers do not make available insulin pumps and their associated replacement supplies
  • Among those contract suppliers who do offer insulin pumps and replacement supplies, many do not offer more than one brand

“These findings also raise concerns with the prospect of expansion of competitive bidding for insulin pumps and supplies to areas outside of the original 9 Competitive Bidding Areas,” Specker said.

To conduct the survey, members of AADE contacted contract suppliers and inquired about the availability of specific brands and models of insulin pumps and replacement supplies.

A total of 29 different suppliers were contacted in the fall of 2014across the nine Metropolitan Statistical Areas (MSAs_ included in the competitive biddings areas).  Of the 29 suppliers, only 17 (58%) reported carrying insulin pumps and 18 (62%) reported carrying replacement supplies and reservoirs.

AADE recommends several simple fixes to the problem:

  • The Center for Medicare and Medicaid Services (CMS) should enforce the requirement that competitive bidding  suppliers make available all Medicare covered insulin pumps and replacement supplies, as indicated through the HCPCS (Healthcare  Common Procedure Coding System) billing  codes within the product category to increase the number of suppliers from which a beneficiary can obtain insulin pumps and replacement supplies
  • Insulin pumps and related supplies should be removed from the current confusing and overly broad product category where they are currently categorized, and redefined as a new product category “Continuous Insulin Infusion Systems and Supplies.” Redefining the product category in this manner would require winning suppliers to stock these items, and help to ensure that patients would have access to the type of insulin pump and related supplies they need to manage their diabetes.

“AADE supports the goal of competitive bidding insofar as it may reduce patient out of pocket costs for products that help patients control their diabetes and improve their health. At the same time, these survey findings clearly demonstrate that changes are needed to ensure that patients receive the equipment that they need,” Specker said.

Read the full survey report

About AADE:

The American Association of Diabetes Educators (AADE) is dedicated to empowering healthcare professionals with the knowledge and skills to deliver exceptional diabetes education, management and support. Diabetes educators are nurses, dietitians, pharmacists and other healthcare professionals who work in partnership with doctors and other healthcare providers to help people manage all the daily aspects of diabetes care, from healthy eating and being active to problem solving and healthy coping. AADE was founded in 1973 and today has more than 14,000 members. 

 
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