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Why does the federal government want to block independent pharmacies from providing much-needed diabetes testing supplies to older homebound patients?
In a clear case of over zealous federal policy-making and glacial government response time, the U.S. Centers for Medicare and Medicaid Services said it will do just that beginning in July. That’s when CMS has decreed it will no longer allow small community pharmacies to deliver diabetic test kits to homebound and long-term care patients on Medicare.
Presumably, the new restrictions were initially prompted by concerns at CMS that suppliers were overcharging Medicare by shifting the delivery of diabetic-testing supplies away from mail-order in favor of community pharmacy-based providers, which were formerly reimbursed by Medicare at a higher rate. But that’s no longer the case; both mail and pharmacy delivery now are on the same payment rate, despite the fact that community pharmacists still provide the added — and more expensive to deliver — value of face-to-face counseling to diabetic patients.
As DSN associate editor Alaric DeArment reported last week, CMS’ move to cut community pharmacies out of the business of diabetes-supply delivery will be a hardship, both to pharmacies and to patients. And more than 40 members of Congress agree: They co-signed a letter May 21, to CMS administrator Marilyn Tavenner urging her to reconsider the policy, and warning that it would “cause disruption in the care provided to Medicare patients.
“While we understand and appreciate the intent of the final rule is to prevent suppliers from adopting ways to circumvent the mail-order process, the recently enacted American Taxpayer Relief Act [ATRA] removes any incentives for suppliers to get around these rules,” the lawmakers told Tavenner. “As a result of ATRA, the payment rates to retail pharmacies were reduced and will now equal those paid to mail-order.”
With “the same level of reimbursements” for both sources of testing supplies, said the congressional reps, “there is no further reason to prohibit home delivery by retail pharmacies.” The lawmakers also pointed out that more than nine of every 10 community pharmacies “make some form of home delivery of diabetes-testing supplies in a month,” and provide “crucial face-to-face counseling and adherence services…to Medicare patients.”
There’s still time for individual pharmacists and pharmacy leaders to join this battle by letting CMS know where you stand.