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.

Click Here To View Or Post Comments

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

Take the Diabetes Health Pump Survey
See What's Inside
Read this FREE issue now
For healthcare professionals only
  • 12th Annual Product Reference Guide
  • Insulin Syringe Chart
  • Insulin Pen Needles Chart
  • Fast-Acting Glucose
  • Sharps Disposal
  • Blood Glucose Meters Chart
  • Insulin Pumps Chart
See the entire table of contents here!

You can view the current or previous issues of Diabetes Health online, in their entirety, anytime you want.
Click Here To View

See if you qualify for our free healthcare professional magazines. Click here to start your application for Pre-Diabetes Health, Diabetes Health Pharmacist and Diabetes Health Professional.

Learn More About the Professional Subscription

Free Diabetes Health e-Newsletter

Top Rated
Print | Email | Share | Comments (0)

You May Also Be Interested In...


Add your comments about this article below. You can add comments as a registered user or anonymously. If you choose to post anonymously your comments will be sent to our moderator for approval before they appear on this page. If you choose to post as a registered user your comments will appear instantly.

When voicing your views via the comment feature, please respect the Diabetes Health community by refraining from comments that could be considered offensive to other people. Diabetes Health reserves the right to remove comments when necessary to maintain the cordial voice of the diabetes community.

For your privacy and protection, we ask that you do not include personal details such as address or telephone number in any comments posted.

Don't have your Diabetes Health Username? Register now and add your comments to all our content.

Have Your Say...

Username: Password:
©1991-2015 Diabetes Health | Home | Privacy | Press | Advertising | Help | Contact Us | Donate | Sitemap

Diabetes Health Medical Disclaimer

The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained on or available through this website is for general information purposes only. Opinions expressed here are the opinions of writers, contributors, and commentators, and are not necessarily those of Diabetes Health. Never disregard professional medical advice or delay seeking medical treatment because of something you have read on or accessed through this website.