Medicare, Test Strips and Competitive Bidding

If you have read my blog in the past, you are aware that on January 1^st, Medicare put into effect a competitive bidding rule for certain areas of the country.  Part of that rule changes how and where you can get test strips.  I have also posted that I am an advocate for People for Quality Care .  PFQC has a Facebook group  that you can follow the activity and problems related to competitive bidding.

This week, I heard about a guy named Lowell having problems getting test strips.  Besides the problems in finding a new supplier, he also was told that he would have to switch brands of test strips.  If you read my first post on this issue (Medicare 2011 DME Changes),  you know that I am concerned about suppliers substituting cheaper strips because they are now getting paid one low price no matter what brand of test strips that they send you. 

Like a lot of other diabetics, I have had problems in the past with test strips.  I tend to run my blood sugar on the low side and I need a test strip that I know will read lows.  I previously wrote about my problems with the Wavesense Presto  meter.  That meter did not read lows for me.  There is a huge difference between being 40 and being 70.  The night that I woke up to EMTs over me, they measured my blood sugar at 37 or 38 so for me, 40 is close to being unconscious!  There was a study published recently that rates different meters.  Unfortunately, the article is no longer free and I am not willing to pay the price to get access to it! 

Lowell was previously using the Bayer Contour meter.  He was sent the Prodigy meter. Lowell was nice enough to send me pictures of the boxes he had.  I don’t know exactly how Bayer rated in that study, but I do know the Contour was listed and was a pretty accurate meter.  I know a lot of people like the Contour meter.  The supply company sent Lowell a Prodigy meter.  I was not familiar with the Prodigy meter so I Googled it.   I did find a bunch of bad reviews that said the Prodigy is frequently 30 points off.  Lowell mentioned the logs required by Medicare.  Medicare only requires logs from people getting more than 3 test strips a day.  Medicare will only give people using insulin more than 3 test strips a day so I think it is safe to “assume” Lowell is using insulin.  It is important that Lowell have an accurate meter so why is he forced to use a meter that is not accurate? 

    

      

Besides accuracy issues, some of us have pumps that require a certain brand of test strips so we want to be able to stick with those strips.  I also have the software with my meter and being able to transfer my readings to my computer is very important because with neuropathy and Dupuytren’s Contracture in my hands, it is very difficult for me to write and maintain the logs required by Medicare.  Being able to print those logs from my computer is something that is a necessity, not a luxury.  If I am not able to provide logs, then I cannot get test strips.  Medicines that people take also can impact certain brands of test strips so it is important to have readings that are not impacted by the medicines that you take. 

I knew in looking thru some of the Medicare stuff that there was a ruling in place regarding the brands of test strips that suppliers have to carry.  After reading about Lowell’s test strip swap, I looked for the ruling on the CMS site.  If you are not aware, CMS stands for Centers for Medicare and Medicaid Services.  It is the agency that sets the rules for Medicare.  If you want to find out what a particular rule is, going to the CMS website is a good place to start. 

I went to the CMS site and I did find the ruling that I was looking for.  In reading that ruling, I found out even more than what I remembered reading in the past.  Here is the link to that ruling. 

This particular ruling is specifically for test strips.  It is called the “50 Percent Rule.”  It was also specifically put in place for the competitive bidding program.  The rule states that a supplier’s bid “covers at least 50 percent or more of the test strip products used by beneficiaries.” 

Another quote from that ruling is “We are finalizing a definition of mail order item and a provision that would prohibit suppliers under a mail order program for diabetic testing supplies from influencing or incentivizing a beneficiary in any way to switch the brand of glucose monitor and testing supplies they are currently using (‘anti-switching rule’)”  … “The ‘anti-switching rule’ would require contract suppliers to furnish the brand of testing supplies that work with the monitor in use by the beneficiary.” 

Now I am not an attorney nor claim to be one, but to me, that rule states that a supplier under the competitive bidding product is not allowed to force a customer to use a different brand of test strips.  Why are customers now being told that they can no longer use the brand of meter they have been using for years?  Is that not in violation of the Medicare ruling? 

If you are a Medicare beneficiary and have been told that you need to change brands of test strips, that supply company is in violation of Medicare rules and you have every right to keep using the brand of test strips you are currently using. 

I previously wrote an article on Reporting Medicare Competitive Bidding Problems.   You can report those problems at People for Quality Care or the American Association for Homecare.  Both of these organizations are trying to bring these problems out into the public so more people are aware of them.  If you are being told that you have to switch strips, that supplier is in violation of Medicare rules.  Please report them and don’t forget to let your Congressman know!