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Controversial Medicare Policy Gets a Makeover—Diabetes Community Still Not Pleased


Dec 1, 1998

DIABETES HEALTH reported in the October 1998 issue that the Durable Medical Equipment Regional Carriers (DMERC) had established an interim policy on Medicare coverage of glucose monitors for people with type 1 and 2 diabetes ("Life, Liberty and the Pursuit of Glucose Monitors").

According to the DMERC proposal, Medicare patients with type 2 diabetes would have 100 test strips covered every four months, or 25 per month. Furthermore, if Medicare patients with type 2 diabetes wanted additional test strips, they would have to receive written consent from their treating physicians and produce a log to receive additional strips. All additional costs associated with receiving the additional strips would not be reimbursed by Medicare.

Reaction to the policy in the diabetes community was less than favorable. Several organizations argued that 25 test strips per month would mean that a person with type 2 diabetes could only test 25 times per month on a given 30 or 31-day calendar month. Others argued that the 25-strip allotment was not enough to be considered a reasonable quality of care.

The Association of Clinical Endocrinologists states that all patients with diabetes should test their blood glucose levels at least twice a day. Jeff Meese of Preferred RX of Ohio felt that the DMERC policy "flew in the face" of the findings from the federally funded Diabetes Control and Complications Trial, which encouraged people with diabetes to test several times per day.

The DMERC, in response to all of the outcry over its interim policy, has decided to revise some of the policy's aspects. According to the new DMERC policy, changes include:

  1. Increasing the utilization guidelines for type 2 patients to 100 test strips and 100 lancets every three months.
  2. Eliminating the proposed form that physicians would have to complete when prescribing supplies in excess of the utilization guidelines.
  3. Changing the requirement that physicians obtain and send the supplier a copy of a log of test results for patients receiving quantities of supplied that exceed utilization guidelines, and
  4. Eliminating the requirement to routinely send a copy of the log to the DMERC.

Jan Norman, manager of the Diabetes Control Program at the Washington State Department of Health, still feels that the 33-strip allotment is not a sufficient number for people who have to test two or three times a day. Furthermore, Norman contends that patients will still have to create a log of all of their test results, and supply it to the providers to receive additional strips and lancets.

"After three months, patients then have to demonstrate that they are testing to the level prescribed beyond the 33 per month by bringing a log book to the pharmacy to get a renewal on extra strips," stated Norman, who feels that if the DMERC wanted to tailor a convenient policy for people with type 2 diabetes, it would have covered no fewer than 50 test strips and lancets per month.

David Holtzman, director of governmental affairs for the American Association of Diabetes Educators (AADE), and one of the more outspoken critics of original DMERC policy, is pleased at the revision, but remains pensive about the new guidelines.

"The initial reaction of the AADE was that we were heartened to see that the DMERC had made some attempt to respond to the widespread criticism laid on their original policy," stated Holtzman. "Our members remain concerned, however, over a policy which may have the effect of requiring some senior citizens, who must test more than once a day, with having to comply with a burdensome, complicated procedure to obtain access to needed test strips."

Holtzman also feels that the DMERC has gone above and beyond the guidelines of the original policy in a way that is deceiving and detrimental to the Medicare patient.

"I don't think it's accurate to say that the DMERC has seen the folly of requiring the physician and patient to supply a log. They've simply gone about it in a different way, and exempted the physicians from having to participate."

The new policy went into effect on October 1, 1998.


Categories: Blood Glucose, Diabetes, Government & Policy, Health Insurance, Type 2 Issues



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