In the Journals Plus

Competitive bidding program limits diabetes supply access

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November 29, 2017

Chris Parkin
Christopher G. Parkin

Medicare beneficiaries with diabetes experienced disruptions in access to diabetes testing supplies after the initial rollout of the CMS competitive bidding program in 2011, and disruptions continued after the national implementation of the program in 2013, study data show.

“This disruption prompted a large percentage of beneficiaries to reduce or cease acquisition of diabetes-testing supplies,” Christopher G. Parkin, MS, of CGParkin Communications in Boulder City, Nevada, told Endocrine Today. “This behavior was linked to increased mortality, hospitalizations and associated costs. The disruption of testing supplies observed in 2011 was even greater when the competitive bidding program was launched nationally in July 2013.”

Parkin and colleagues evaluated data on 529,627 Medicare beneficiaries with a diabetes diagnosis and record of insulin treatment in 2009 to evaluate the effect of the Medicare competitive bidding program national rollout in 2013 and to determine whether adverse effects observed in 2011 continued. Records for patients who lived in any of the nine pilot program implementation areas (TEST; n = 43,939) were separated from those from all other areas (NONTEST; n = 485,688).

Researchers specifically looked at changes that occurred from 2012 to 2013, which included the first 6 months after the national rollout.

The percentage of the full study population that reported full acquisition of insulin and self-monitoring blood glucose supplies increased from 29% in January 2013 to 31.2% after the national implementation. Those reporting full acquisition of insulin and partial or no acquisition of SMBG supplies increased from 23.6% to 37.5% during the study period, for a 59% increase among the full study population with less than full access to testing supplies.

In the TEST group, full acquisition of insulin and partial or no SMBG supplies acquisition remained stable before 2011, increased after the pilot implementation, decreased slightly in January 2013, and increased significantly during the first 6 months of the national implementation. In the NONTEST group, full insulin acquisition and partial or no SMBG supplies acquisition remained stable from 2010 to 2013 and increased significantly after the national implementation.

Among the full study population, partial or no insulin acquisition and full SMBG supplies acquisition decreased from 23.5% in January 2013 to 11.7% after national implementation, for a 50.3% decrease in those reporting full acquisition of diabetes testing supplies. Further, partial or no insulin acquisition and partial or no SMBG acquisition decreased by 18.4% after the national rollout in the whole population.

“The competitive bidding program is harming Medicare beneficiaries with insulin-treated diabetes and should be suspended until CMS can demonstrate its ability to effectively monitor the effects of the program and ensure that Medicare beneficiaries, a population that is more vulnerable to both the acute and chronic complications of diabetes, are protected from further harm,” Parkin said. “A comprehensive analysis of the clinical consequences of the competitive bidding program is needed. Unfortunately, CMS does not make data available that would facilitate this analysis.” – by Amber Cox

For more information:

Christopher G. Parkin, MS, can be reached at

Disclosures: Parkin reports he receives funding for research and consulting services from Abbott Diabetes Care, Asante, Bayer Diabetes Care, CeQur, Dexcom Inc., Eli Lilly and Company, Insulet Corp., MannKind Inc., Roche Diabetes Care and Sanofi, and is an employee of CGParkin Communications. Please see the study for all other authors’ relevant financial disclosures.