Ask your doctor if ???? is right for you.–heard all too often on TV
Congresswoman Susan W. Brooks R-Indiana) writes:
Remember the Protecting Access to Diabetes Supplies Act that Congresswoman Diana DeGette, Rep. Tom Reed, and I introduced on Monday? Yesterday that bill was included in a House Committee on Energy and Commerce where we discussed ways to strengthen and improve Medicare. Medicare beneficiaries across the country and in IN-05 who live with the daily challenges associated with need access to test strips that work best with their bodies to monitor their glucose levels. This bill will help access supplies that allow them to best control their diabetes.
- Politicians often advocate consumer choice–shop for insurance that meets your needs, ask your doctor for this product or that, search for low cost drugs and services. However, most consumers lack the time and expertise to make wise choices.
- Consumers are unlikely to know which test strips work with their meter. Inferior, low-cost strips are a danger.
- There is a black market in test strips. Insurers warn that black market test strips may be inappropriate. Selling test strips on the black market is illegal and drives up the cost of insurance.
- Manufactures suggest using only those test strips made to work with specific meters. This sounds self-serving, but following the meter manufacturer’s recommendation is no doubt the safest plan. Meters with similar names may require different strips; read the labels carefully.
The text of H.R. 3271 is incomprehensible to anyone but experts. Here is the CRS summary:
This bill amends title XVIII (Medicare) of the Social Security Act to modify provisions relating to Medicare’s competitive acquisition program (through which rates are set through a competitive bidding program rather than by an established fee schedule) with respect to diabetic testing strips. Specifically, the bill requires the Centers for Medicare & Medicaid Services (CMS) to:
- use specified data to determine whether a bid satisfies certain requirements related to volume of coverage with respect to such products,
- reject a bid if the bidder does not demonstrate its ability to furnish such products in a manner consistent with its bid, and
- establish a process to monitor the extent to which an entity continues to cover the product types included in its bid.
The CMS may terminate a contract if it determines that an entity, for reasons other than product discontinuation or market-wide shortage, fails to maintain ready access to such products included its bid.
In addition, the bill specifies that an entity furnishing such products to beneficiaries under the program: (1) must furnish to each beneficiary a brand of strips that is compatible with the beneficiary’s home blood glucose monitor, (2) may not attempt to influence or incentivize a beneficiary to switch the brand of either type of product, and (3) must contact and receive a request from a beneficiary no more than 14 days prior to dispensing a refill to the beneficiary.
From the CRS Summary, one can infer:
- This bill is the work of a manufactures’ lobby.
- Low cost manufacturers have captured business with unrealistic low bids.
- Insurers have preferred low cost providers over more costly brands.
- Insurers must authorize requests for refills in a timely manner.
Competition is often held to be important in keeping costs down, so the prohibition against influencing a beneficiary to change brands is surprising–it goes against the practice of preferring generic drugs. Once my insurer did require me to change to a new glucose meter. I had no objection: the insurer paid for the new meter, and I have no reason to prefer one to another. This would evidently be prohibited if H.R. 3271 became law.
Whatever its merits, with Congress preoccupied with larger healthcare issues, and with insurers presumably lobbying against it, H.R. 3271 is likely to die in committee.