Mail-order program: OIG provides CMS with before, after picture

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Tuesday, June 24, 2014

WASHINGTON – How has the national mail-order program for diabetes supplies affected brand choice?

CMS now has a before and after picture thanks to the Office of Inspector General (OIG).

The OIG published this week the results of a study to determine the market shares of test strips for the three-month period prior to the start date of the program on July 1, 2013. It found:

·      Two types of strips accounted for about 34% of the Medicare mail-order market share;

·      Four types of strips accounted for 51%; and

·      Ten types accounted for 75%.

In a previous study to determine the market shares of test strips for the three-month period after the start date of the program, the OIG found:

·      Two types of test strips accounted for about 45% of the Medicare mail-order market share;

·      Three types accounted for 59%; and

·      Ten types accounted for 90%.

“CMS may choose to use the results of this report for program analysis purposes and to evaluate the effect of the competitive bidding program on brand choice,” the OIG states.

To conduct its most recent study, the OIG used a sample of 1,210 claims for a population of about 1.36 million claims for test strips provided to beneficiaries from April to June 2013.

A requirement outlined in the Medicare Improvements for Patients and Providers Act (MIPPA) prohibits CMS from awarding contracts for test strips to suppliers that don’t demonstrate that their bid covers at least 50%, by volume, of all types of test strips.