Welcome to the AADE Advocacy Action Center
The AADE Advocacy Action Center provides federal and state legislative information related to diabetes education, the National Diabetes Prevention Program, medical nutrition therapy, and diabetes self-management training/education. Get involved by staying informed and taking action!
Advocacy Action Center News
Congress Passes Major Fix to CMS Competitive Bidding Program for Diabetes Testing Supplies
Including Language from the Protecting Access to Diabetes Supplies Act increases protections for people with diabetes after numerous reports of the program’s flaws
CHICAGO – February 9, 2018 – Today marked a big win for people in the diabetes community, after Congress included language from the Protecting Access to Diabetes Supplies Act in the FY2018 and FY2019 budget deal. The language will make several effective changes to the Competitive Bidding Program (CPB), including strengthening the 50 percent and anti-switching rules. This comes after AADE released several beneficiary surveys dating back to 2011, showing the program put people with diabetes at unnecessary risk.
“AADE applauds Congress and specifically Congressman Tom Reed and Congresswoman Diana DeGette for advocating for this bill that will not only help fix a broken system, but put the lives of people with diabetes first,” said AADE Director of Advocacy Kurt Anderson. “Our surveys show that the CMS CBP put beneficiaries at unnecessary risk through forced switching of diabetes supplies to unfamiliar or unsuitable products.”
AADE surveys in 2011, 2013 and 2017 showed the current program reduced beneficiary choice and access to commonly used diabetes testing supplies (DTS). A 2016 National Minority Quality Forum report showed a direct link to increases in mortality and complications, inpatient admission and supplier costs.
Major fixes to the CMS CBP include:
Strengthening of 50 Percent Rule
Under the CBP, suppliers are paid the same amount by Medicare for Diabetes testing supplies regardless of what they supply to a beneficiary. As such, suppliers have a powerful economic incentive to maximize profits by offering the least expensive supplies obtainable. Congress was concerned that these incentives would lead suppliers to no longer offer many of the test systems commonly used by beneficiaries, and that beneficiaries therefore might not be able to find replacement supplies for their current test systems. Congress enacted the “50 Percent Rule” to ensure that beneficiaries would continue to have access to the same test systems that they used prior to implementation of the CBP by requiring that mail order suppliers make available at least 50 percent of all types of DTS on the market before implementation of the CBP.
The manner in which CMS has implemented the 50 Percent Rule has rendered this statutory protection inadequate. CMS interpreted the statute as applying to supplier bids only; CMS does not require suppliers to comply with the 50 Percent requirement once a contract is awarded. Moreover, CMS gave suppliers a 10 percent credit toward satisfying the 50 percent requirement merely for selecting “Other—Not Listed,” a catch-all designation not associated with a particular test system or product. The current bill would include the following changes to this rule:
Strengthening of Anti-Switching Rule
- Requiring bidding suppliers to attest to (subject to a good faith effort exception) an ability to obtain an inventory of strips by volume consistent with the inventory mix provided in that supplier’s bid;
- Establishing and maintaining a surveillance program to ensure that suppliers comply with the 50 Percent Rule, and authorizing CMS to terminate a supplier who fails to comply with the 50 Percent Rule;
- Requiring CMS to use multiple sources of data, and data that measures consumption and utilization of DTS by individuals other than just those Medicare beneficiaries who purchase DTS through Medicare-participating mail order suppliers, for purposes of measuring compliance with the 50 Percent Rule; and
- Barring CMS from giving bidding suppliers additional percentage credit toward satisfying the 50 Percent Rule by selecting “Other—Not Listed.”
CMS established the anti-switching Rule to protect beneficiary and physician choice of glucose meters. This rule requires suppliers to furnish the test system requested by the beneficiary and prohibits contract suppliers from influencing or incentivizing beneficiaries to switch their current glucose monitor and testing supplies brand to another brand.
CMS has likewise rendered this protection inadequate. Recent Inspector General reports show a shift in brands purchased by beneficiaries through the CBP. This shift is inconsistent with beneficiary purchasing patterns from retail pharmacies, suggesting that mail order suppliers may be switching beneficiaries in spite of the rule. Once a beneficiary is switched, it becomes difficult for the beneficiary to purchase desired products from another supplier, like a retail pharmacy. When a mail order supplier sends Medicare beneficiaries unwanted supplies and submits a claim for payment for those supplies, claims for additional supplies (e.g., if the beneficiary were to go to a retail pharmacy seeking preferred supplies), will be denied because the beneficiary’s supply benefit has already been exhausted for that period. If the supplier continues to send supplies and submit claims, the beneficiary cannot break the cycle and obtain supplies of choice. This bill strengthens the anti-switching rule by making the following changes:
- Codifying the anti-switching rule.
- Allowing beneficiaries to break the claims cycle by requiring suppliers to contact and receive a refill order from the beneficiary not more than 14 days prior to dispensing a refill.
- Requiring suppliers to verbally provide beneficiaries with an explanation of the beneficiary’s rights, including the beneficiary’s right to receive DTS compatible with the beneficiary’s blood glucose testing system, the right not to be influenced or incentivized to switch blood glucose testing systems, the right to obtain strips from another mail order supplier or retail pharmacy, and the right to reject unwanted DTS.
AADE is a multi-disciplinary professional membership organization dedicated to improving diabetes care through innovative education, management and support. With more than 14,000 professional members including nurses, dietitians, pharmacists, exercise specialists, and others, AADE has a vast network of practitioners working with people who have, are affected by or are at risk for diabetes. Learn more at www.diabeteseducator.org
, or visit us on Facebook (American Association of Diabetes Educators
), Twitter (@AADEdiabetes
) and Instagram (@AADEdiabetes
AADE holds Advocacy Webinar
On December 20, AADE hosted a first of its kind webinar, Political Policy Recap and Look Ahead,
which featured representatives from AADE's Washington, DC Lobbying firm, Baker
Donelson discussing the major political, legislative, and regulatory highlights
of 2017, in addition to outlining the policies AADE will be watching in
you missed the webinar and would like to watch it, you may do so by clicking here.
Federal Government and Legislators Try to Improve
the Medicare Competitive Bidding Program for Blood Glucose Monitoring Supplies
Since implementation of the competitive bidding program (CBP) for
blood glucose monitoring (BGM) supplies purchased through mail-order suppliers
in January 2011, reports had repeatedly surfaced suggesting that product
choices were limited and that beneficiaries may not have had access to the full
range of products that were available before the program began. In 2011 and
again in 2013, the AADE conducted studies to evaluate the extent to which
Medicare’s contract suppliers offered and made available different brands and
models of BGM supplies. In those studies, diabetes educators surveyed contract
suppliers authorized to sell BGM supplies to Medicare beneficiaries through
mail order to determine which products each supplier offered and made
available, and compared that information with the information available in the
Medicare supplier database.
Through these studies, AADE found the following:
- Contract suppliers did not make available
all of the products that were listed on the Medicare.gov Supplier Directory
- Many of the products available to
Medicare beneficiaries before implementation of Round 1 were no longer
available through NMO suppliers.
In early 2017, AADE completed a third study which found the following:
- The number of brands of BGM supplies
carried by NMO suppliers has fallen nearly 50 percent since the start of the
- The number of models of BGM supplies
available under NMO is less than half the number available in 2009;
- Many suppliers do not offer models
covering 50 percent of the market share of BGM supplies; and
- Suppliers do not provide consistent
information about inventory to prospective customers.
In addition to AADE’s studies and work that a number of organizations
such as the National Minority Quality Forum have done on this issue, members of
Congress are concerned about the problems with the CBP including the accuracy
of certain BGM strips people with diabetes are receiving.
On December 6, 2017
the co-chairs of the Congressional Diabetes Caucus sent a letter to The Honorable
Eric D. Hargan Acting Secretary, Department of Health and Human Services. In the letter Congressman
Tom Reed of New York and Congresswoman Diana DeGette of Colorado state:
“As co-chairs of
the Congressional Diabetes Caucus, we write to express concern about the
accuracy of blood glucose testing systems furnished to Medicare beneficiaries.
Critical daily treatment decisions are based on readings from blood glucose
monitors and test strips. We therefore ask that you apprise the Caucus on what
steps, if any, the Centers for Medicare and Medicaid Services (CMS) and Food
and Drug Administration (FDA) are taking to ensure seniors with diabetes
receive products that work as intended.”
DeGette is also sponsoring a piece of legislation called the Protecting Access
to Diabetes Supplies Act of 2017.
As pharmacychoice.com writes:
H.R. 3271 strengthens protections for Medicare beneficiaries
purchasing blood glucose testing equipment and supplies through Medicare's
National Mail Order Competitive Bidding Program. H.R. 3271 would address these
shortcomings so that in future, CBP rounds beneficiaries have access to
preferred and familiar test systems.
H.R. 3271 will strengthen the "50 Percent Rule" first
established by Congress in 2008. By requiring suppliers' bids to include at
least 50 percent of the types of test systems on the market before the
implementation of CBP, this rule seeks to ensure that beneficiaries are likely
to have access to the testing systems they used before CBP. However, a recent
study by the American Association of Diabetes Educators showed that under CBP,
beneficiaries actually have access to far fewer types of testing systems. H.R.
3271 will require suppliers to demonstrate that they have an intent and ability
to maintain an inventory of products consistent with their bid and require
suppliers to adhere to the 50 percent rule throughout the life of their
contract. Further, this bill bolsters the Anti- Switching Rule, a beneficiary
protection established by CMS through a regulation that prohibits suppliers
from encouraging beneficiaries to switch from one testing system to another.
H.R. 3271 would codify and enhance the Anti-Switching Rule by ensuring
beneficiaries know their rights to receive compatible test strips with their
blood glucose monitors.
URGENT – Starting December 1, 2017 Arriva Medical no longer
supplying diabetes testing supplies for Medicare recipients
Medicare’s largest mail order supplier of diabetes testing
supplies (DTS), Arriva Medical, is closing its doors on December 1, 2017.
Because Arriva supplies a majority of DTS for the Medicare mail-order program
and is the only supplier of One Touch, their void in the marketplace and to our
patients could be devastating. Patients may not be able to get the
supplies they need in a timely fashion and they will need to find alternative
suppliers of their DTS.
AADE has spoken to CMS about the issue and is working to
gather more detailed information as to what steps you and your patients can
take to prepare.
However, initially, there are some immediate steps that can
be taken to assist patients.
Arriva listed the following information on the website:
If you are a
Medicare patient and you want to continue receiving diabetes testing supplies
through the mail, Medicare may pay for 80% of those supplies if they are
provided by a supplier that contracts with Medicare. To find a Medicare
supplier, follow the instructions below:
for finding Medicare supplier:
- Visit www.medicare.gov/suppliers
zip code and click "Go"
"Mail-Order Diabetic Supplies"
"Search" at the bottom of the page
Or you can
call Medicare at 1-800-Medicare (1-800-633-4227).
If you are not
a Medicare beneficiary, please contact your insurance provider for information
regarding a new supplier.
You can also
purchase diabetes testing supplies at a local pharmacy or other supplier, but
out-of-pocket costs may differ based on brand and supplier.
You and your
new supplier can obtain your prescription from your physician.
If you need to
access your prescriptions or other records after November 30, 2017, please
visit www.arrivamedical.com for further instructions.
AADE will keep you informed about this issue and
developments related to getting your patients their supplies.
Announcing the 2018 Public Policy Forum
AADE will hold its annual Public Policy Forum on June 8 and June 9 in Rosemont IL.
In past iterations, this event has been held in Washington, DC
with a special focus on the promotion and advancement of the federal
legislative agenda. However, with the ongoing trend of
government decentralization, it has become increasingly important to
advocate at the state and local level. With this in mind, the AADE Advocacy
team crafted a Public Policy Forum program designed to train members on how to
engage with policymakers locally.
In 2017 over 80 participants from 37 states joined us at the
Forum to hear from retired legislators; active lobbyists; the Directors of the
Illinois Department of Public Health, National Minority Quality Forum, National
Health Council; and a panel of AADE member-activists who have taken the reigns
of diabetes-related advocacy in their home states.
If you couldn’t make it to the 2017 Public Policy Forum, or if you
want to review a favorite presentation, you may view the
presentation slide deck here.
AADE Advocacy Priorities