In life, wouldn’t it be nice if there was an easy button to fix problems that we have in our lives? You have seen the Staples commercial, the one with the red easy button! It would be so nice to just press a button and poof our problems would be solved. Life is not lived in commercials, cartoons, sitcoms or even movies. Life is lived in the real day-to-day actions of individuals who are passionate about what they believe in.
I have never been afraid to use my voice to help myself and others. Several weeks ago, I started inquiring and advocating for persons with diabetes who have Medicaid. On April 1, Iowa Medicaid changed the way that they reimburse diabetes testing supplies. Providers were notified in January that there would no longer be a preferred diabetes meter and test strips and that billing would change to include diabetes testing supplies as durable medical equipment. This is where things become interesting. Pharmacies were billing testing supplies at the point of sale, as a prescription item. Under the change, pharmacies will need to bill the testing supplies under a DIFFERENT Medicaid contract specific for durable medical equipment. Currently, in the Des Moines metro area, we know of two pharmacy chains that are set up to bill and are educated on the ways of this type of billing. In rural Iowa, there are bigger issues. In my search for an answer, I emailed the Director of Medicaid and the Director of the Department of Human Services. I don’t know what I was expecting. I can honestly tell you, that I didn’t bargain for what was offered. I received an email back that stated that the Directors would be happy to meet with me! I assembled my posse of diabetes advocates, assimilated diabetes statistics and had meetings with influential folks in the diabetes community prior to this meeting.
On Monday, April 29, myself, Courtney Slater (AADE Co-President), Dr. Jason Kruse (ADA CLB and practitioner) and Matt Pitlick (Iowa Pharmacy Association) met with the Directors and their posse of people. I opened the meeting by explaining why I had contacted Mr. Randol and Mr. Foxhoven. I discussed that patients were not getting the care that they deserved. I shared the story of a 14-year old T1D patient who was without testing supplies for 5 days until her parents could drive the 50 miles to the nearest contracted pharmacy to pick them up and patients in the Des Moines metro area who went to their pharmacy and were told that the supplies were no longer covered. With the implementation of this new ruling, patients are struggling to get truthful information. Due to the short planning period given, many pharmacies were not yet contracted to provide DME and that DME suppliers and pharmacies that were signed up to provide the service weren’t aware that diabetes testing supplies needed to be billed this way now. Dr. Kruse spoke about his viewpoint as a provider and the slow process and increased paperwork that he and his staff were enduring. We were met with EXCUSES.
Excuse #1: “The blame cannot lie solely on the state.” Why not? The state gave pharmacies less than three months’ notice to get contracted with three entities. It takes a lot more time than three months to get contracted. The state doesn’t reimburse for these materials so many pharmacies and DME suppliers aren’t contracted because they can’t afford to lose money. New Information gained during this discussion: The State has updated its reimbursement rates to be more competitive and will retro pay entities to April 1.
Excuse #2: “This is how we billed diabetes testing supplies prior to 2009 when we didn’t have a preferred product.” That was 10 years ago folks. Shouldn’t we update the way we do things to align with the technology and movement of the current world.
Excuse #3: “It will be too tedious to enter all of the glucose meters, test strips and lancets into the system.” Instead, we’ll push the EASY button and go with this. It saves us time and money.
I am sure that it comes as no surprise that we were met with a HARD NO. Nothing will change. Medicaid is proceeding with its implementation of diabetes testing supplies as DME. If you encounter pharmacies or other DME suppliers who are not contracted with Iowa Medicaid and the private MCOs, please have them contact the Iowa Pharmacy Association or Iowa Medicaid to get the contracting process started.
In my professional career, if I made these same excuses to a patient or a colleague, I would not be taken seriously and likely would never be sought after again for recommendations. I understand to the elected and appointed officials that this is a BUSINESS but to me it is people’s lives and I am not OK with pushing the easy button.