Some seniors on fee-for-service plans may need to change ordering method
FRIDAY, June 28, 2013 (HealthDay News) -- Starting July 1, seniors with diabetes should be able to save some money when they buy the blood sugar testing supplies they need to monitor their disease.
That's when Medicare kicks off a new cost-saving program that will require beneficiaries to order these supplies through a national mail-order program or a Medicare-approved pharmacy.
Right now, Medicare pays about $77.90 per month for 100 blood sugar test strips and lancets (the needles used to prick the finger to draw a drop of blood), according to the Center for Medicare and Medicaid Services.
Medicare recipients currently pay 20 percent of that cost, which averages to $15.58 a month. Once the national mail-order program kicks in, the total cost will drop to $22.47, due to a competitive bidding process. That means the cost to the Medicare recipient will only be around $4.50.
Over a year, each person with diabetes on traditional Medicare will save $133.
"We're hopeful that approved providers for diabetic testing supplies will offer people a better value for their needed mail-order purchases and ensure that consumers and taxpayers are getting the best price for their supplies," said Ariel Gonzalez, director of federal health and family advocacy for AARP.
This change is expected to affect 2.3 million Medicare beneficiaries who are on traditional fee-for-service Medicare. This change doesn't apply to people on Medicare Advantage plans, such as an HMO or PPO, according to the CMS.
The program is part of a competitive bidding process initially set up in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. The competitive bidding process applies not only to diabetic testing supplies, but also to other types of medical equipment, such as wheelchairs, walkers, hospital beds and oxygen equipment. It's expected to save taxpayers nearly $26 billion between 2013 and 2022, according to CMS. The program is also expected to save an additional $17.2 billion for Medicare beneficiaries during that same time period.
So, if you're on traditional Medicare and you need diabetic testing supplies, you may need to make some changes to how you order supplies. The first step is to find a national mail-order supplier. You can do this by visiting medicare.gov/supplier or by calling 800-MEDICARE (800-633-4227). They can give you a list of suppliers who are under contract with Medicare to provide the new prices.
If you prefer getting your supplies locally, you can also get your supplies from a pharmacy or store that accepts Medicare assignment, according to CMS. Ask your pharmacist if they accept Medicare assignment before getting your prescription filled. Any pharmacy or store that says it accepts Medicare assignment can only charge you for any unmet deductible (Medicare Part B) and your 20 percent coinsurance. Stores and pharmacies that don't accept Medicare assignment can charge you more.
The cost of diabetic supplies will be the same for mail-order suppliers and pharmacies or stores that accept Medicare assignment, according to CMS.
The national mail order program applies to people with both type 1 and type 2 diabetes. It covers blood sugar test strips, control solution for the test strips, lancets, the lancing device and batteries for your blood sugar monitor.
National mail-order suppliers have to include coverage for more than 50 percent of the currently available test strips on the market, according to CMS. If the supplier you've chosen doesn't offer your brand of test strips, ask your doctor if you can use an alternative brand. If there's a medical reason for you to use a particular test strip, your doctor can document this, and the supplier can either given you the exact brand you need, or help you find another supplier who will.
Unsolicited phone calls from mail order suppliers aren't allowed under CMS rules. If you get a call pressuring you to switch suppliers, report the call to Medicare at the phone number given above. In addition, CMS recommends never giving your Medicare number or personal information to anyone who calls you.
Learn more about the national mail-order program from Medicare.gov (http://www.medicare.gov/what-medicare-covers/part-b/dme-diabetes-national-mail-order-program.html ).
SOURCES: Center for Medicare and Medicaid Services, http://www.cms.gov; Ariel Gonzalez, director, federal health and family advocacy, AARP, Washington D.C.