Diabetes and Medicare
How the New Medicare Law Will Affect People with Diabetes (ARA)
With the introduction of Medicare Prescription Drug and Modernization Law of 2003 signed by President Bush, a good precedent is set for a guaranteed prescription drug coverage and screenings for heart disease, cancer and diabetes.
For the 18.2 million Americans who suffer from diabetes, this act paves the way for even the coverage of insulin and syringes more than just the initial screening and drug coverage. Now, the physicians have the authority to order diagnostic screening tests for even the patients who don’t show any symptoms for diabetes. This is a shot in the arm for the American Diabetes Association (ADA), the agency that fought for the reforms. “Under the old law, neither of these critical things were covered,” says Michael Mawby, national vice president of government relations for the American Diabetes Association (ADA)
Introduction of this law has eliminated a practice existing hitherto, wherein the patients were given a general medicine prescribed by the doctor which benefited the drug companies at the expense of patients care. This practice named “Trading Out” helped the company save money till now.
Section 302, paragraph 5 of the Bill states, “the Secretary may establish a process under which a physician may prescribe a particular brand or mode of delivery of an item or service if the item or service involved is clinically more appropriate than other similar items or services.” It helps the patient to receive the focused medicine rather than general medicines what their doctor prescribes. Thus the practice of “trading out” is eliminated.
“We’re glad to see Washington affirming the value of putting the control where it belongs, in the doctor’s hands,” says Gary Janson. He happens to be the president of the American Medical Supplies. This is a Florida-based company that serves clients all over the United States; clients who are in need of diabetic supplies. “It has always been our practice to give our patients exactly what their doctor has prescribed, but not everyone does it that way,” says Janson. “Some companies have been giving their customers generic testing supplies.”
He comments that companies “trade-out” that too purely for monetary reasons. “Medicare only authorizes between $35 and $38 for testing strips. If the provider has to pay more than that, they lose money on the deal. The only way to make up the difference is to drive down your cost by providing patients with less expensive machines.”
Monica English, a resident of Kingsville happens to be a recent victim of trading out. Her experiences are stated in the quotes for your references. “I saw a commercial on television offering what sounded like a great deal for diabetes patients — a brand new blood sugar testing monitor if I switched to their company,” says English. She being a diabetic patient has been using a glucose blood test monitor regularly for the last five years. As her machine was five years old, she decided that it was high time that she got a new one, in spite of her being content with her old machine.
The day she received her machine, she was in for a big surprise. It was not a brand that she was expecting. She called them and told that it was not the machine that she was expecting and that she needed one of the new Accu-Check meter; one that would accept the Comfort curve testing strips she was currently using. Her replacement was one of the brands that she wanted, but the problem came to her in another way. It was a model that did not accept her strips. Says English, “The Comfort Curve strips require just a small drop of blood. The strips that came with the new machine required a lot more, making the testing painful to do; and I couldn’t even get it to accept the strips. I must have wasted 10 of them before I managed to set the machine in motion.”
After her traumatic experiences regarding the machine, she decided to switch companies again. This time she went in for Janson’s company based on an advice from her friend. Now “American Medical supplies” provide her with the testing strips that she requires to carry out her tests. They are also providing her with the insulin that is required to maintain her blood glucose level within the specified limits. With the company’s relation with Medicare, they are also able to settle her billing requirements. This adds to providing her with facilities for billing her secondary insurance company.