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How the New Medicare Law Will Affect People with Diabetes (ARA)

Now that President Bush has signed the Medicare Prescription Drug and Modernization Act of 2003 into law, sweeping changes that will affect a lot of people are under way. For the first time, there will be guaranteed prescription drug coverage and screenings for heart disease, cancer and diabetes.

For the 18.2 million Americans who suffer from diabetes, the benefits go way beyond the initial screening and drug coverage. The bill also ensures that insulin and syringes will be covered, and establishes the authority for physicians to order diagnostic screening tests for patients who are at risk for the disease, even if they don’t show any symptoms. “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), an agency that lobbied hard for the reforms.

An added bonus, the potential for elimination of a practice that benefits drug companies at the expense of patient care. “Trading out” is when a patient is given a generic version of the medication or supplies ordered by their doctor so the company can save money.

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.” In other words, the patient will receive exactly what their doctor prescribes.

“We’re glad to see Washington affirming the value of putting the control where it belongs, in the doctor’s hands,” says Gary Janson, president of American Medical Supplies, a Florida-based diabetic supplies company that serves clients throughout the United States. “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 says companies “trade-out” for purely 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 of Kingsville, Mo., is a recent victim of trading-out. “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 had been using the same machine for five years, and was happy with it, but thought it was about time to get a new one.

When her new machine arrived, it wasn’t the brand she was expecting. “I told them on the phone I wanted a new Accu-Check meter that takes Comfort Curve testing strips. What I got was their brand name machine and it didn’t accept my 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.”

Unhappy with her experience, English switched companies again. This time, based on a friend’s advice, she went with Janson’s company. American Medical supplies her with testing strips and the insulin she needs to regulate her blood sugar. The company also handles billing services for Medicare and her secondary insurance company.

Courtesy of ARA Content

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