North Carolina

Tuesday, January 26, 2010

RALEIGH, N.C. - Providers here had barely a month to adjust when the state in October awarded a contract to a single manufacturer to provide diabetes supplies to Medicaid patients.

The deal with Charlotte-based Prodigy Diabetes Care is expected to save the state $4.4 million over two years. The program launched Nov. 15.

There was no request for proposal or public comment period, which raised concerns--and eyebrows.

"They were very close-lipped," said Beth Bowen, executive director of the North Carolina Association of Medical Equipment Services (NCAMES) association. "But, after the contract was signed, Medicaid and Prodigy opened their doors to us."

Right now, the biggest headache for providers: They must purchase Prodigy meters so they can replace patients' old meters and then apply for rebates from Prodigy, which requires additional paperwork and can only be done quarterly.

"We've got 150 patients that we switched," said Kimberly Lynn, HME operations manager for Reidsville-based Carolina Apothecary. "That puts a financial burden on us upfront."

Reimbursement for diabetes supplies hasn't changed, but providers are concerned that the cost of Prodigy products--meters, strips, lancets and insulin syringes--could be higher. That could lead to access problems, said provider Kim Brummett.

"If I can't afford to stock it, I may choose not to," said Brummett, vice president of contracting and reimbursement for Greensboro-based Advanced Home Care.

Many industry stakeholders expressed concern that certified diabetes educators (CDEs) would be unfamiliar with the products and that patients would be reluctant to switch meters.

"We were aggressive from the outset to get out there in person and meet with as many of the CDEs as we could to make sure they knew our product and how to use it," said Prodigy spokesman Pete Bosak. "Any time there's change, people are going to be resistant. It's human nature." hme