Lawmakers Challenge Proposed CMS Payment Changes for Diabetes Technology
The House and Senate Diabetes Caucuses have formally voiced their objections to proposed changes by the Centers for Medicare and Medicaid Services (CMS) regarding diabetes technology payments. These changes could significantly influence how patients access essential diabetes management devices.
Lawmaker Concerns Over CMS Payment Changes for Diabetes Technology
In June, the CMS unveiled a proposed rule that would include insulin pumps and continuous glucose monitors (CGMs) in a competitive bidding program. This proposal also aims to alter the payment structure, shifting from upfront payments for devices to a monthly rental model.
In an October letter to CMS Administrator Mehmet Oz, caucus leaders sought to prevent the finalization of these changes. Senators Jeanne Shaheen (D-N.H.) and Susan Collins (R-Maine), along with Representatives Diana DeGette (D-Colo.) and Gus Bilirakis (R-Fla.), highlighted fears that the new payment structure would limit access to CGMs and insulin pumps.
Potential Impact on Diabetes Technology Access
- The new model could restrict the number of suppliers providing durable insulin pumps and CGMs.
- Current manufacturers, responsible for maintenance and software updates, might not be able to meet patient needs.
- Legislators warned that the proposal risks reducing the range of choices for patients.
In their correspondence, lawmakers expressed concern that the proposal would push beneficiaries toward a “one size fits all” approach, potentially compromising patient care. They emphasized the need for diverse options in diabetes technology to meet individual health requirements.
Support for Continuous Innovation
While lawmakers support advancements that allow for more frequent updates to technology, they believe that solutions exist that would not undermine access. Of note, there is a national coverage determination request underway to align Medicare coverage for insulin pumps with established standards of care.
AdvaMed, a prominent medtech lobbying group, echoed these concerns. CEO Scott Whitaker emphasized the ongoing challenge of patient access to necessary diabetes technology under current policies. He asserted that any changes leading to reduced access would be misguided.
In August, AdvaMed urged the CMS to address significant flaws in the proposed rule before implementing a competitive bidding program for durable medical equipment. The organization’s commitment to improving diabetic care through enhanced access remains steadfast amidst these ongoing discussions.
