Lawmakers from both the House and the Senate Diabetes Caucuses expressed strong opposition to changes proposed by the Centers for Medicare and Medicaid Services (CMS) regarding payment structures for diabetes technology. Their concerns center on new policies for continuous glucose monitors (CGMs) and insulin pumps.
Concerns About Proposed Changes
In June, CMS put forth a proposed rule to integrate insulin pumps and CGMs into a competitive bidding program. This would shift payment models from upfront costs to a monthly rental for devices.
In an October letter addressed to CMS Administrator Mehmet Oz, the co-chairs emphasized the potential negative impact on access to these critical diabetes management tools. They voiced worries that these changes could complicate beneficiaries’ access to needed technologies.
Impact on Beneficiaries
- Legislators fear limited supplier options for durable insulin pumps and CGMs.
- Maintenance and updates would fall to a few suppliers instead of manufacturers.
- Reduced product variety could limit choices for patients.
Senators Jeanne Shaheen (D-NH) and Susan Collins (R-ME), along with Representatives Diana DeGette (D-CO) and Gus Bilirakis (R-FL), highlighted the risk of a “one size fits all” model. This approach may not adequately meet individual patient needs.
Alternative Solutions
While supporting the principle of facilitating technology upgrades more frequently than every five years, the caucus members argue there are more effective methods for achieving this goal. They pointed to the ongoing national coverage determination request, aiming to align Medicare’s insulin pump coverage with current standards of care.
Industry Reactions
The medical technology lobbying organization AdvaMed also joined the call against finalizing these proposed changes. CEO Scott Whitaker remarked that many patients currently lack necessary access to diabetes technology that could enhance their quality of life.
“Policies that decrease access are counterproductive,” Whitaker stated. He noted that the current proposals needed serious revision before reinitiating the competitive bidding program for durable medical equipment.
With diabetes tech firms like Tandem Diabetes Care and Insulet monitoring the situation, initial assessments indicated minimal direct impact on their operations. However, ongoing scrutiny of CMS’s proposed changes remains essential as advocacy efforts continue to emphasize patient access and technology effectiveness.
