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While the changes are intended to save money for both the government and beneficiaries, serious questions have arisen. Will patients' choice of supplies be reduced? Will the quality of the supplies change? Will seniors properly understand what's going on?
While the ins and outs of any health insurance plan can be confounding-let alone one created by the government-there are some answers, and some reassurances along with them. Here are some of them:
Question: What's changing, anyway, and why should I care?
Answer: As of July 1, folks enrolled in Medicare who receive their testing supplies through the mail will have to get them through the Medicare National Mail Order Program. There are 18 suppliers that have contracts with the government to do this, and the covered supplies are test strips themselves, lancets and lancet devices, glucose meter batteries, and test strip control solution. Meters are not part of the program.
This change is important for two big reasons. If you already receive your supplies through a mail-order company that isn't one of the 18 with government contracts, you will need to switch. And not all of those 18 suppliers will offer all brands of testing supplies.
There are a handful of other details, which we'll cover later, but those are the main points.
Question: That sounds kind of awful. Are there any benefits to the changes?
Answer: Yes! These changes will save both people with diabetes and the government money, because the suppliers have bid to provide low-cost supplies. To get the contracts, those companies were willing to accept less money from the government to access bigger numbers of patients.
For people who receive strips through the mail, for instance, co-pays could drop from $15.58 for 100 strips to $4.49. That's quite a bit of savings!
It's not some sort of teaser rate, either. That will be your new cost for buying test strips. Costs may change years in the future, of course, but the overall goal is to dramatically reduce what both patients and the government pay.
Question: What if I get my glucose testing supplies from a brick-and-mortar store?
Answer: Thanks to a recent law passed by Congress, retail pharmacies that contract with Medicare have to offer the same prices as the mail-order pharmacies. So if your pharmacy is part of the program, you'll pay that same $4.49 for 100 strips. Amazing, right?
There's a big caveat, though. You'll want to ask your pharmacy if it accepts "Medicare assignment," meaning that it has agreed to be part of the program. If it doesn't, you may have to pay more to get your supplies from that store. Most big-box store pharmacies will be included, because they have a lot of patients and will benefit from the volume.
Some smaller, independent pharmacies may be leaving the program because they're being reimbursed less by the government. As always, the best option is to ask for information.
Question: Will I have to change the test strips I use?
Answer: This is the biggest question hanging over the change. Some advocates have raised alarms over the switch, claiming that the cost reductions will lead to more foreign-made, lower-quality test strips and supplies flooding the market.
In general, these concerns seem misplaced. By law, the suppliers are not allowed to urge patients to switch test strip brands. They can't even tell patients about other options unless they're asked to. And if beneficiaries have a brand that is medically required, providers must work with them to find a satisfactory outcome.
If you simply prefer a certain brand, though, you may have to shop around at the 18 mail-order providers or local pharmacies. Each one of those providers is legally required to offer at least half of the brands currently on the market, so chances seem pretty good that someone will have what you're looking for.
Question: Does this program really apply to everyone?
Answer: It applies to all beneficiaries of traditional Medicare in all 50 states and U.S. territories. It doesn't apply to those in the newer Medicare Advantage plans (such as an HMO or PPO program).
Question: This all still seems complicated. How can I get help?
Answer: This is the other commonly raised concern. Older or less technologically savvy beneficiaries might be confused about their options under this new plan. According to The New York Times, 2.3 million Medicare beneficiaries received diabetes supplies through the mail last year. That's a lot of folks to educate.
There is help available, though, and it's easy to remember and tell others about. First, if you have any questions at all, you can call 1-800-MEDICARE (1-800-633-4227). Second, if you want to know about the 18 suppliers and what they offer, you can visit www.medicare.gov/supplier. Once there, you can type in your ZIP code and learn about the options available to you.
Question: Costs aside, is this all a good thing?
Answer: Probably. Diabetic test strips are mass-produced items, and their costs can vary wildly from one store and one brand to another. That has made the government suspicious, particularly in the case of mail-order products, of fraud. Cutting the number of suppliers to those who passed a competitive bidding process means that the government is sure these companies are charging realistic prices.
And if you're a taxpayer, you should probably welcome this move, too. The government will be able to save money by contracting with these suppliers and reduce Medicare costs. Given the huge number of people forecast to be entering the program over the next few years, that's definitely a good thing over the long term.
"It's been an area where there's been a lot of fraud, a lot of overutilization and a lot of studies saying Medicare pays too much, the taxpayer pays too much and beneficiaries with a 20 percent co-pay pay too much, too," Laurence Wilson, the director of Medicare's chronic care policy group, told the Times.
Question: Any final thoughts?
Answer: As people with diabetes, we also want to encourage people to check their blood sugars regularly. For all of the technology available to help control the disease, there's nothing as effective as the simple blood glucose test. If tells people with diabetes exactly where they are, and by implication, what they need to do to take control of their condition.
Making blood glucose testing easier and cheaper is a good thing. And if this program ends up doing that for Medicare recipients, it's probably a good thing too.
3 comments - Jul 19, 2013