A new report released earlier this month examining Medicare diabetes testing supplies (DTS) appears to reinforce three things about mail order health care: 1) it’s not for everyone 2) it results in wasteful “auto-shipping” of medical products and 3) it’s more expensive than advertised.
The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) conducted the study for officials at HHS’ Centers for Medicare & Medicaid Services (CMS). They presumably noticed a trend of seniors switching from mail order to non-mail providers, like community pharmacies, soon after Round 1 of CMS’ competitive bidding program took effect in certain segments of the country.
According to OIG, the use of non-mail order diabetic testing supplies (those provided by community pharmacies and others) increased by 33 percent while mail order diabetic testing supplies decreased by 71 percent. To figure out why patients switched away from mail, OIG interviewed beneficiaries and examined the claims.
First, OIG’s findings underscore the need for protecting patient choice because mail order is not for everyone. Ten percent of beneficiaries made the switch from mail due to either unsatisfactory service or because they didn’t like mail. The rest essentially had to switch because either their previous provider either didn’t win the competitive bid or didn’t offer the product they used. Presumably most, if not all, of these seniors had the option to choose a mail order provider but decided against it. This comes on top of similar patient questions about mail order, recently reported by J.D. Power and Associates.
Second, the report further validates concerns by NCPA member pharmacists and previous statements by CMS of witnessing mail order oversupplying and wasted health care dollars that can occur through “auto-shipping” of DTS. Five percent of beneficiaries received unsolicited DTS. Beneficiaries reported receiving an average of five unsolicited boxes of DTS.
One beneficiary told OIG she did not know that she is supposed to call her supplier and request a refill for DTS, saying “about every 3 months, DTS strips that I did not order arrive. The supplier just sends strips.” Another patient received eight unsolicited DTS boxes from an entity that is not her current DTS supplier.
Third, the report raises questions about the cost assumptions of mail order DTS. Many of those unrequested supplies are likely to go to waste, without CMS accounting for it. Moreover, for 20 percent of beneficiaries, mail order billed CMS inappropriately at a higher rate, overcharging Medicare.
Community pharmacies play a vital role as the safety net in providing DTS to beneficiaries. As shown by the report, beneficiaries turn to their local community pharmacist when they can no longer obtain the product that their prescriber has determined is best for them through mail and when they are dissatisfied with mail. As such, community pharmacists are motivated to stock products which local physicians prescribe and beneficiaries prefer.
Surveys have indicated that, if required to participate in competitive bidding of DTS or to take the comparable reimbursement, the overwhelming majority of independent community pharmacies would be forced to stop offering the products, creating access concerns for patients. That’s why NCPA continues to urge exempting independent pharmacies, such as by enacting H.R. 1936, The Medicare Access to Diabetes Supplies Act.