Medicare Begins National Mail Order for Diabetic Testing Supplies for ALFs

We are repeating this article because of questions asked at the recent VCAL Symposium about obtaining diabetic supplies for residents in assisted living facilities.

On July 1, 2013, the Centers for Medicare & Medicaid Services (CMS) is implementing a new National Mail-Order Program for assisted living facilities (ALFs) for Medicare diabetic supplies such as blood glucose testing strips, lancets, and replacements batteries for blood glucose monitors. Under the new nationwide system, rather than having an approved amount of $78 for 100 test strips and lancets, Medicare’s approved amount will be about $22 – and beneficiary co-pays will drop from approximately $15 to under $5. To save money under the new system, beneficiaries need to use a Medicare national mail-order contract supplier. The national suppliers can be found here, and then enter the relevant zip code. This mail order program only applies to residents of ALFs. The statute prohibits separate payment for DME furnished in nursing homes.

Beneficiaries or their representatives can still go to any local pharmacy or store enrolled with Medicare and buy supplies there. Under the new system, however, local pharmacies may not deliver these supplies. The change in diabetic testing supplies is part of Medicare’s new Durable Medical Equipment Competitive Bidding Program, which also caused costs and co-insurance to decrease.

Going forward, national mail-order contract suppliers can’t charge residents more than any unmet deductible and 20 percent coinsurance. Local stores accepting Medicare also can’t charge more than the deductible and 20 percent coinsurance. If a local store does not accept Medicare, however, it may charge more for those supplies.

During the past several weeks, assisted living communities have been receiving letters from national suppliers and local pharmacies informing them about the new system. The National Center for Assisted Living is gathering member questions to discuss with CMS officials and will be providing additional information.