Association of Diabetes Care & Education Specialists

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Major Changes to Medicare Competitive Bidding Program in Recent Budget Deal

Mar 14, 2018

AADE played a major role in this victory

Just last month, Congress passed and the President signed a two-year budget deal. Among the many provisions in this legislation is a section which deals with the Medicare Competitive Bidding Program for diabetes testing supplies (CBP). The CBP allows Medicare recipients to obtain their testing supplies in the mail via vendors who contract with Medicare. At the inception of this program, our members noticed that there were issues which negatively impacted people with diabetes. One of the most egregious issues included blood glucose strips, to which they had become accustomed, being switched to an unfamiliar brand because the vendor did not carry that particular brand of strip. This unfamiliarity often lead to people giving up on checking their blood glucose, and some died as a result. AADE was at the forefront of exposing these issues by surveying the contractors in this program. Starting in 2011 AADE wrote and published three “Secret Shopper Survey” studies of this program. In addition, AADE has been working with many allies and Congress to address and improve the CBP. 

Late last year, a bill was introduced in Congress which would address some of the issues with the CBP. AADE supported this legislation. Numerous attempts were made to attach the language from this bill to other pieces of legislation. The language was successfully attached to the budget bill. The two most important provisions include:

Strengthening the 50 Percent Rule

Under the CBP, suppliers are paid the same amount by Medicare for DTS regardless of what they supply to a beneficiary. As such, suppliers have a powerful economic incentive to maximize profits by offering the least expensive supplies obtainable. Congress was concerned that these incentives would lead suppliers to no longer offer many of the monitoring systems commonly used by beneficiaries, and that beneficiaries therefore might not be able to find replacement supplies for their current test systems. Congress enacted the “50 Percent Rule” to ensure that beneficiaries would continue to have access to the same monitoring systems that they used prior to implementation of the CBP by requiring that mail order suppliers make available at least 50 percent of all types of diabetes monitoring supplies on the market before implementation of the CBP.

Strengthening the Anti-Switching Rule

CMS established the Anti-Switching Rule to protect beneficiary and physician choice of glucose meters. This rule requires suppliers to furnish the monitoring system requested by the beneficiary, and prohibits contract suppliers from influencing or incentivizing beneficiaries to switch their current glucose monitor and strips brand to another brand. 

While the legislation will not correct all of the CBP’s issues, it is a relevant and big first step in improving the CBP.

The tenacity and dedication of our members to people with diabetes was the key to this victory!

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