Latest AADE Survey Finds Even Fewer Choices for Diabetes Supplies in Medicare

More than 5 years after it began, CMS’ competitive bidding program (CBP) for mail-order diabetes testing supplies is still limiting choice and access for Medicare beneficiaries trying to manage their disease, according to a new survey from the American Association of Diabetes Educators (AADE).

The results are consistent with AADE surveys in 2011 and 2013, as well as a peer-reviewed study that appeared last year in Diabetes Care, the leading journal of the American Diabetes Association. That study, by the National Minority Quality Forum, found disruptions in the testing supply chain were not merely inconvenient, but in fact caused the untimely death of Medicare beneficiaries with diabetes.

People with diabetes depend on testing systems and supplies to check blood glucose levels, often several times a day. Accurate blood glucose readings are needed to know how much insulin to use, to calibrate equipment, and to make dietary adjustments. Those who test infrequently are likely to have increased blood glucose variability, which can lead to health problems. Poor glucose management can cause blindness, kidney damage, cardiovascular disease, or even lower limb amputations.

“If you’re doing self-management, one of the cornerstones is that you have consistent access to quality products,” Kurt Anderson, director of Federal and State Advocacy for AADE, said in an interview with The American Journal of Managed Care^®. For Medicare patients using the mail-order program, “that just hasn’t been the case.”

Since CMS began competitive bidding for supplies in its mail-order program, Medicare patients with diabetes have complained about not being able to afford the supplies their doctors recommend, causing them to ration what they have on hand or switch to an unfamiliar product. Not all diabetes testing supplies work the same way, and the AADE report says patients who are frustrated by an unfamiliar product may test less frequently, if at all.

CMS has defended the mail-order bidding program, saying it saves taxpayers millions of dollars and prevents fraud. Last fall, CMS said it had systems in place to detect poor health outcomes among diabetes patients using the program. A report last fall from by the Government Accountability Office supported CMS’ claims. However, AADE said CMS has put the 2019 round of bidding on hold, a move the group “applauds.”

Anderson said the most recent survey, taken in November 2016, found problems that educators have encountered from the beginning, and some things are worse now than in 2011. “It certainly hasn’t gotten any better,” he said.

AADE’s survey found the following:

• Fewer testing supply brands are available in the mail-order program today; the number has fallen 50% since the CBP began.
• The number of models of testing systems available is less than half the number available through Medicare in 2009, before competitive bidding began.
• Suppliers offer inconsistent information to callers about when products will be available.
• CMS is not enforcing a bidding requirement, which says suppliers must offer models that cover 50% of the market.
• Overall, the vendors offering products today are not the same ones who took part in the CBP when it began. Only 4 of the 11 contract suppliers from the first round of competitive bidding are still with the program.

The one improvement? AADE found that information on the Medicare website tracking the availability of supplies through the mail-order program is more accurate than in prior surveys.

AADE surveys the market with a “secret shopper” format; a team of diabetes educators called 11 suppliers to check on the availability of products. Five different educators contacted each supplier to record whether supplies were available, and if not, the reason why. Because responses varied, AADE counted a product as available if at least 3 of its educators were told the product was available.

The AADE report takes note of the shrinking number of brands available. When the program began, there were 38 brands; with the second round of bidding, that number fell to 34. Today, there are only 20 brands available. “This nearly 50% reduction in brands … underscores the complexities that Medicare beneficiaries experience when selecting a testing system,” the report states.

The HHS Inspector General has found that the brands most popular with Medicare beneficiaries before bidding began are no longer available. “This is of concern because, as suppliers limit choice, patients are at risk of being switched to (diabetes testing supplies) other than what was recommended by their healthcare team or preferred by the patient,” the report states.

Doctors and diabetes educators try to carefully match testing systems with patients’ needs, only to be forced to switch, the report states. Each time this happens, diabetes educators must use valuable appointment time re-educating patients on how to use new supplies, instead of teaching other management strategies.

Anderson said some policymakers or purchasing supervisors don’t grasp that diabetes testing supplies are not interchangeable. “That’s been one of the main problems,” he said. “Every product has nuances … It can be confusing to people if they get something new, and they’ll just stop testing.”

AADE will discuss the latest survey findings with CMS, including members of the new administration. “It certainly is our hope that the administration will be open to looking at the program more closely,” he said.

Thank you again for your help on the coverage of this survey. Just wanted to see if you’re able to make an update on the article. I’ve been asked if you could please update the two bullets below to what is in red. This reflects a change in wording that was made to the report, but not to the press release.