Competitive Bidding

Diabetic Supplies National Mail-Order Bid On the Way

While the timing of the national mail-order bid for diabetic supplies has not yet been announced, here are the basics of what the program will look like:

According to a recent notice from CMS:

"MIPPA [Medicare Improvements for Patients and Providers Act of
2008] specifies that a national competition for mail-order items
and services is to be phased in after 2010. The regulation includes
provisions to implement a national mail-order competition for
diabetic supplies in 2011 that includes all home deliveries while
maintaining the local pharmacy pickup choice for beneficiaries. We
are also implementing the special "50 percent rule" mandated by
MIPPA and implementing an anti-switching requirement as part of the
terms of the competitive bidding contract."

While the timing of the national bid has not yet been announced,
here are the basics of what the program will look like:

  • CMS defines "mail order" as anything other than when the
    beneficiary or caregiver picks up supplies at the local pharmacy.
    In other words, "mail order" includes items shipped or delivered to
    the beneficiary's home, regardless of the method of delivery, and
    "non-mail order" includes items that a beneficiary or caregiver
    picks up in person at a local pharmacy or storefront.

  • A special rule requires contract suppliers to provide, at a
    minmum, 50 percent of the different types of diabetic testing
    products on the market by brand and model name. This will apply to
    any bid program after Round 1, national or other, for these
    products. The Office of Inspector General has conducted a study to
    determine the products that make up most of the Medicare market,
    and CMS may use the data when determining whether providers'
    mail-order test strip bids comply with the MIPPA "50-percent rule."
    (See "Top
    19 Medicare Mail-Order Test Strips
    " for a chart.)

  • There is a prohibition included against influencing and
    incentivizing beneficiaries to switch their brand of monitor and
    testing supplies from those they are currently using. CMS believes
    this requirement is essential if it is to enforce the "50-percent
    rule."

  • Read the main story, "Know
    Your Numbers
    ," to learn about providers in the
    diabetes sector face competitive bidding prices that don't add
    up.



comments powered by Disqus