AADE survey: disturbing problems continue with Medicare’s competitive bidding program, calls on Congress to fix – March 28, 2017

AADE just released a concerning 25-page report sharing results from a November 2016 survey of 11 Medicare competitive bidding program (CBP) mail order BGM suppliers. The report is clear in its conclusion: Medicare is “harming persons with diabetes” by limiting access and choice to blood glucose meters and strips through this program. Similar to previous studies (2011, 2013), five diabetes educators called up CBP mail order suppliers, seeking information about available BGMs. Results were disturbing, albeit unsurprising:

• The number of BGM brands carried by mail order suppliers has fallen nearly 50% since the start of competitive bidding, down to just 20 this time around (including many, many brands we’ve never heard of);
• The number of BGM models available under mail order suppliers is down to 36, less than half the number available in 2009;
• Most suppliers do not offer BGM brands/models covering 50% of the market (a benchmark required in the bidding process, but not required in for ongoing participation); and
• Suppliers do not provide consistent information about available brands/models to prospective customers (for only two out of 11 suppliers were the available brands consistent from call to call).

The table below, sourced from the Office of Inspector General (April-June 2016), is republished in the AADE report and shows market share estimates for different BGMs in the Medicare mail-order market. Some lesser known brands have significant market share, including Prodigy Diabetes Care at 28% (#1), Omnis Health at 11% (#3; Embrace BGM), Trividia Health at 11% (#4; TRUEtest). and i-Sens at 7% (#5; CareSens). LifeScan’s older-gen OneTouch Ultra meter has a 23% market share (#2), by far the highest of any brand name supplier. Together, these five meters have 80% of the market, according to the Office of Inspector General.

The AADE report calls on Congress and CMS to address flaws in the program in two ways: (i) require suppliers to provide the same mix of brands/models as those listed in their original bid; and (ii) regularly audit competitive bidding program suppliers to ensure that they meet quality standards. Both of these are obvious and yet not happening right now – it is basically pathetic. AADE’s press release, however, does applaud CMS’ plan to delay Round 2019 of the Competitive Bidding Program so that the process can be overhauled to reflect evidence and best practices. We can only hope things improve, but it’s hard to be optimistic.

These results are not surprising, given AADE’s previous work and last year’s Diabetes Care paper, but they are alarming and reinforcing. As AADE notes, “The lack of choice forces beneficiaries to switch to unfamiliar or unsuitable testing systems, and can have dire health consequences.” Of course, many of these unknown meters also raise significant concerns about accuracy and strip quality – particularly for seniors dosing insulin.

Close Concerns Questions

Q: Will CMS and Congress respond to this report?

Q: Will competitive bidding for BGMs be overhauled, given this report and other data on the program?

Q: If Medicare could redesign competitive bidding from scratch, what would be done differently to save costs AND maintain quality?

Q: Will DTS’ post-market surveillance program make a difference?

Market Share Estimates for Mail-Order Diabetes Test Strips (April-June 2016), Office of Inspector General Report

-- by Adam Brown and Kelly Close