Dive Brief:
- The co-chairs of the House and Senate Diabetes Caucuses urged the Centers for Medicare and Medicaid Services not to finalize proposed changes that would affect how the agency pays for diabetes devices.
- In June, the CMS issued a proposed rule to include insulin pumps and continuous glucose monitors in a competitive bidding program. It would also change payments to a monthly rental rather than a contract where devices are paid for upfront.
- In a letter sent to CMS Administrator Mehmet Oz in October, caucus leaders raised concerns that the changes would reduce and complicate access to CGMs and insulin pumps. Medtech lobbying group AdvaMed issued a statement on Monday also urging the CMS not to finalize the proposal.
Dive Insight:
This summer, diabetes tech companies, including insulin-pump makers Tandem Diabetes Care and Insulet, said they were watching the CMS proposal. At the time, they did not forecast much of an impact on their businesses.
In their letter, Sens. Jeanne Shaheen, D-N.H., and Susan Collins, R-Maine, and Reps. Diana DeGette, D-Colo., and Gus Bilirakis, R-Fla., raised concerns that a few suppliers would be responsible for furnishing durable insulin pumps and CGMs to beneficiaries if the proposal were made final. These suppliers would also be responsible for maintenance, software updates and recalls. Currently, manufacturers are responsible for support.
“We also are concerned that these proposed policies will have the unintended consequence of reducing choices for CGM or durable insulin pump beneficiaries,” the legislators wrote. “Suppliers would not be required to carry all types and combinations of CGMs and durable insulin pumps under this proposal, which would push beneficiaries closer to a one size fits all model that would not meet their needs.”
They added that while they support the goal of allowing people to switch to newer technologies more often than every five years, they believe there are other ways for the CMS to achieve this. The caucus leaders also noted that there is currently a national coverage determination request to align Medicare coverage of insulin pumps with the standard of care.
AdvaMed CEO Scott Whitaker said in a statement that even under current policies, too many patients lack adequate access to diabetes technology that could improve their health.
“Any policies that undermine instead of increase access are the wrong direction,” Whitaker said.
In comments sent to Oz in August, AdvaMed recommended that the CMS “address the serious flaws with the proposed rule” before restarting its competitive bidding program for durable medical equipment.
