According to a recent notice from CMS:
"MIPPA [Medicare Improvements for Patients and Providers Act of
2008] specifies that a national competition for mail-order items
and services is to be phased in after 2010. The regulation includes
provisions to implement a national mail-order competition for
diabetic supplies in 2011 that includes all home deliveries while
maintaining the local pharmacy pickup choice for beneficiaries. We
are also implementing the special "50 percent rule" mandated by
MIPPA and implementing an anti-switching requirement as part of the
terms of the competitive bidding contract."
While the timing of the national bid has not yet been announced,
here are the basics of what the program will look like:
CMS defines "mail order" as anything other than when the
beneficiary or caregiver picks up supplies at the local pharmacy.
In other words, "mail order" includes items shipped or delivered to
the beneficiary's home, regardless of the method of delivery, and
"non-mail order" includes items that a beneficiary or caregiver
picks up in person at a local pharmacy or storefront.
A special rule requires contract suppliers to provide, at a
minmum, 50 percent of the different types of diabetic testing
products on the market by brand and model name. This will apply to
any bid program after Round 1, national or other, for these
products. The Office of Inspector General has conducted a study to
determine the products that make up most of the Medicare market,
and CMS may use the data when determining whether providers'
mail-order test strip bids comply with the MIPPA "50-percent rule."
19 Medicare Mail-Order Test Strips" for a chart.)
There is a prohibition included against influencing and
incentivizing beneficiaries to switch their brand of monitor and
testing supplies from those they are currently using. CMS believes
this requirement is essential if it is to enforce the "50-percent
- Read the main story, "Know
Your Numbers," to learn about providers in the
diabetes sector face competitive bidding prices that don't add