Senate Bill Would Keep CGMs and Insulin Pumps Out of Medicare Competitive Bidding for Five Years

Sens. Jeanne Shaheen, D-N.H., and Susan Collins, R-Maine, have introduced a bill that would keep continuous glucose monitors (CGMs) and insulin pumps out of Medicare's competitive bidding program for five years, HME News reported on March 12.

The Diabetes Interventions Addressing Barriers to Enrollment, Technology, and Education Services Act, or DIABETES Act, S. 4037, would also expand Medicare coverage of diabetes self-management training sessions, in which diabetes educators train Medicare patients to manage the disease and use diabetes technologies. Shaheen is the sponsor and Collins cosponsored it on March 10, according to Ripon Advance, which reported that the bill has been referred to the Senate Finance Committee. The two senators co-chair the Senate Diabetes Caucus.

Response to the next bidding round

The bill follows a Centers for Medicare & Medicaid Services decision to bring CGMs and insulin pumps into the next round of the durable medical equipment competitive bidding program. CMS's final home health rule, released in late November, placed those items in a Remote Item Delivery segment created for equipment typically supplied repeatedly by mail order, HME Business reported. Based on 2024 claims data, CMS said in the rule: "We believe this would result in approximately 10 national contract suppliers for the CGM/insulin pump product category."

A March 11 press release from Shaheen's office said the exemption "comes after Shaheen and Collins urged CMS Administrator Mehmet Oz not to finalize a proposal the lawmakers warned could reduce and complicate patient access to CGMs and durable insulin pumps," as quoted by HME Business.

According to HME Business, the bill's findings say that reclassifying CGMs and insulin pumps "as items requiring frequent and substantial servicing when they are phased into the competitive bidding program will have numerous unintended consequences." The bill also says Medicare does not separately reimburse for the algorithms and software that drive automated insulin delivery systems, and calls on the Secretary of Health and Human Services to recognize that software as a separately payable supply, the outlet reported.

Senators and suppliers

"Delays or disruptions in coverage of diabetes technologies can cause a decline in patient health, particularly for those enrolling in Medicare," Collins said, as quoted by HME News. Shaheen said: "Americans living with diabetes should not have to jump through hoops to access life-saving care."

The American Association for Homecare, which represents home medical equipment suppliers, said the provisions delaying the inclusion of diabetes products are on pages 18-19 of the bill. Its president and CEO, Tom Ryan, said the legislation "is an important step forward in protecting access to these critically important products and maintaining a robust supplier infrastructure to support patients." The association said it would provide messaging and resources for asking senators to support and co-sponsor the bill.

According to the senators, the bill has been endorsed by the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the American Association of Clinical Endocrinology, the Diabetes Leadership Council, the Diabetes Patient Advocacy Coalition and the Diabetes Technology Access Coalition, HME News reported.

HME Business reported that competitive bidding registration and bidding dates are due to be announced in late spring to early summer.