Community pharmacies may be forced to stop selling diabetes testing supplies, NCPA warns

July 24, 2012

A new policy proposal by the Centers for Medicare and Medicaid could force independent community pharmacies to stop selling diabetes testing supplies, and beneficiaries would not have access to the care they need from their local pharmacies, according to a statement from the National Community Pharmacists Association.

A new policy proposal by the Centers for Medicare and Medicaid Services (CMS) could force independent community pharmacies to stop selling diabetes testing supplies, and beneficiaries would not have access to the care they need from their local pharmacies, according to a statement from the National Community Pharmacists Association (NCPA).

Bill Popomaronis, RPh, NCPA vice president of LTC/HHC/NIPCO, spoke at a public meeting held this week by CMS regarding the potential reduction in reimbursements for diabetes testing supplies using the “inherent reasonableness” standard to the Medicare fee schedule amounts for non-mail-order diabetes testing supplies. The policy would lower reimbursements to an unsustainable level for independent community pharmacies that sell medical products to help patients with diabetes ascertain blood glucose levels.

“Community pharmacists are indispensable to helping combat diabetes, whether it is the counseling they offer, the medications they dispense, the lifestyle modification classes they provide, or the wide variety of testing supplies they carry,” Popomaronis said. “However, that dynamic will be harmed if these small business pharmacies are forced to walk away from a pricing structure for diabetic testing supplies that only a large self-warehousing chain pharmacy or mail-order supplier can make work.”

The CMS policy comes at a time when other impediments to selling diabetes testing supplies under Medicare Part B have been proposed. In his testimony, Popomaronis explained a number of concerns associated with the “inherent reasonableness” standard, including:

  • Reimbursement reductions that are financially devastating to small pharmacies that cannot purchase supplies in bulk like the large chain stores or mail-order suppliers;

  • A lack of evidence that the fee schedule is grossly excessive as compared to the cost to independent pharmacies to purchase these supplies;

  • The rationale by CMS that savings and success for patients with diabetes means driving down per unit costs, which is contrary to the integrated care models that are promoted by healthcare systems in the public and private sectors; and

  • A failure to acknowledge that CMS money is wasted on mail-order diabetes testing supplies that are shipped, as demonstrated by the large number of unused prescription drugs generated by mail-order supplies in the One Year Implementation Update to Round 1.

“Independent community pharmacists are working hard to provide the best care and access to beneficiaries while working with CMS to improve quality of care and drive down long-term costs. The facts are, with drastic cuts to reimbursement for diabetes testing supplies, beneficiaries will no longer have access to the care they need and deserve,” Popomaronis added.