According to APhA's Focus newsletter released March 19th, Medicare will drastically cut reimbursement for current diabetes testing supplies. Starting July 1, 2013, the goal is to reduce reimbursement amounts to the national mail-service fee schedule. This means the amount reimbursed will be $22.47 for 100 test strips and 100 lancets. This reduction in reimbursement correlates with the expansion of Medicare's current Durable Medical Equipment into the new Durable Medical Equipment, Prosthestics, Orthotics, and Supplies (DMEPOS). They have initiated their Competitive Bidding Program which apparently "has saved millions for taxpayers and beneficiaries". However, this incredibly low reimbursement means that community pharmacies currently participating in the program may have to consider dropping it. Most community pharmacies are paying more than the proposed reimbursement amount and would constantly be losing money on every transaction. They will have to find a balance between pleasing patients and their bank accounts. Moreover, July 1 will also mark the end to many community pharmacies being able to deliver to Medicare patients that are homebound or live in assisted-living facilities. These patients will now only be able to receive their testing supplies through the mail by companies that have contracts with CMS to provide mail order service. This creates another deficit to community pharmacies who serve assisted-living patients. Not only will this change affect pharmacies, but patients as well. Pharmacists are there to counsel patients, discuss testing strategies, as well as outcomes, and work with physicians to provide the optimal treatment plans. This will no longer exist. Yes patients will be receiving their diabetes testing supplies cheaper, but their optimal outcome may decline.
This change will have a severe impact on the community pharmacy I am currently working in and we will have to decide if we wish to continue the program or not. Final decisions have to be made by April 15 of this year. We also offer diabetes education services, but the reimbursement changes for these services is currently unknown. Many community pharmacies may be opting out of the program altogether and the impact on patients is yet to be established. Right now it is just a waiting game.
