On July 1, Medicare opens a national mail-order program that will dramatically drop the prices the government pays for those products but patients will have to use designated suppliers. The goal is to save taxpayers money but seniors should see their copays drop, too.
Don't care about the convenience of mail delivery? Just over half of the 4.2 million diabetics with traditional Medicare coverage used mail-order last year, but starting July 1 beneficiaries also can get the new lower price at drugstores enrolled in the Medicare program.
"Those who like the face-to-face interaction with the pharmacist have that choice," stressed Jonathan Blum, Medicare deputy administrator. "We want to preserve both options."
It's the biggest expansion yet of a larger, and somewhat controversial, initiative that's predicted to save taxpayers nearly $26 billion over the next decade by cracking down on waste and fraud in the medical equipment industry. Diabetics aren't the only Medicare patients affected. Depending on where they live, patients who rent home oxygen gear and hospital beds, or who need power wheelchairs, walkers and certain other equipment also could see changes in their suppliers and lower prices as a pilot test of this so-called competitive bidding program expands from nine metro areas to a total of 100 on July 1. Medicare is supposed to apply the lower pricing nationally by 2016.
The diabetes initiative is the first to go nationwide - and Blum said it should put an end to unscrupulous practices such as shipping cartons of supplies to diabetics who haven't run out yet and billing Medicare for the cost.
The concern: Potentially hundreds of thousands of older patients may have to switch mail-order suppliers. The American Diabetes Association worries they won't get the word before their supplies run short - or might be pressured to switch to a cheaper brand of blood-sugar monitor and the matching supplies even though that's against the rules.
"We're sort of torn, truthfully," said Krista Maier, the association's associate director of public policy. "It will save the Medicare program money, which is good for its sustainability. The challenge is ensuring that beneficiaries' testing of their blood glucose isn't disrupted."
Here are some questions and answers about the program:
Q: What's the big change?
A: Until now, hundreds of mail-order companies could bill Medicare for the test strips, lancets and other supplies that diabetics use to measure and track their blood sugar. Under the new national program, Medicare patients can order from only 18 mail-order companies that won government contracts and will be subject to more oversight. (The change doesn't apply to Medicare Advantage patients.)
Check the list at HTTP://WWW.MEDICARE.GOV/SUPPLIER or by calling 1-800-MEDICARE. Some companies operate under multiple names.
Q: What if the new companies don't sell my brand?
A: Medicare's list shows different suppliers sell a mix of top-selling brands as well as generics - and you're not required to change your existing monitor. But you may need to shop around or get a doctor's note that specifies you need a specific type, so plan ahead.
Q: What's the price difference?
A: Medicare has paid about $78 for 100 test strips and lancets, just over a month's supply for someone who tests his or her blood sugar three times a day. Remarkably, that rate was higher than other insurers typically pay. Starting July 1, that reimbursement will drop to about $22. The patient copay is 20 percent, so it will drop from about $15 to less than $5.
Q: What if I want to buy at my local drugstore instead?
A: Ask if it accepts "Medicare assignment," meaning it has to honor the July 1 prices. Some large chains are reassuring customers that they're participating. But pharmacies that aren't enrolled in Medicare are allowed to charge patients more.
Q: How did the program work in the nine test cities?
A: Medicare says patients had plenty of supplies. But surprisingly, mail-order claims dropped the first year. The Department of Health and Human Services' inspector general discovered that some suppliers were billing Medicare for drugstore-sold supplies - which at the time were reimbursed at a higher rate - even though they actually shipped cheaper mail-order supplies. Congress later closed that loophole, mandating the same reimbursement for drugstores and mail-order starting July 1.
Q: What's happening with other medical equipment?
A: That part of the initiative has hit some bumps. Medicare had awarded contracts to nearly 800 suppliers of those items but it turned out that some didn't have certain licenses required by state authorities. Medicare says it has voided 30 of 96 supplier contracts in Tennessee, but that enough remain to do the job. It is investigating the situation in Maryland.
The home supply industry's American Association for Homecare, which opposes Medicare's competitive bidding program, says the licensing issue is a symptom of broader problems. Members of Congress last week asked Medicare to delay the program's expansion, but that's not expected to happen.
The "Get Covered America" campaign will include door-to-door visits by volunteers, brochures handed out at farmers markets and churches and, possibly, partnerships with sports leagues and celebrities, said Anne Filipic, a former White House official who recently became president of Enroll America, the group sponsoring the campaign.
The group's research shows 78 percent of uninsured adults don't know about opportunities that will be available to them in 2014 under the Affordable Care Act, Filipic said Tuesday during a phone call with reporters. The campaign is expected to cost tens of millions of dollars, including a seven-figure media ad buy.
"If they don't know about it, then they won't enroll," Filipic said. "We've done our research. We know people want to know what the law means for them in a `just the facts' sort of way."
Health and Human Services Secretary Kathleen Sebelius has drawn criticism from Republicans for making fundraising calls for Enroll America. Earlier this month, Sebelius told members of Congress she made five phone calls for Enroll America, two of which involved actual fundraising solicitations, to Robert Wood Johnson Foundation and H&R Block, entities not regulated by HHS.
She also called three health care companies to "suggest that the entities take a look at the organization (Enroll America)" but did not make a fundraising solicitation to those three. They were Johnson & Johnson, Ascension Health and Kaiser Permanente.
Sebelius said the HHS secretary has the legal authority to raise money for initiatives that support government health programs.
The federal government itself will spend millions on marketing and advertising about the health law, but the spending will vary greatly across the nation because some Republican-led states haven't sought federal dollars for ad campaigns.
Enroll America's campaign will start with 50 events in 18 states, Filipic said. The group has staff on the ground in eight states, including Texas and Florida and others where government officials have resisted key parts of Obama's health law such as the expansion of Medicaid.
"We know that most of the uninsured don't know about the new coverage options coming this fall, let alone whether or not their state is expanding Medicaid," Filipic said. "Many of the uninsured are eligible for Medicaid today but have not enrolled, and those who are not eligible for Medicaid may qualify for coverage through the marketplace."
Obama's national health law requires that nearly all Americans have health insurance beginning in 2014 or pay a penalty. New insurance marketplaces are scheduled to be operating in every state by Oct. 1. People who are uninsured will be able to comparison-shop for affordable health plans on these websites and many will qualify for tax credits to help them pay for coverage.
The organization is building a predictive model to determine where to target the uninsured and will track which of its tactics are most effective, Filipic said.
"We're going to be doing a lot of testing to see what works," she said. "What moves someone to attend an event or call a phone number? We'll be doing a lot of work to test and analyze that."
In a parallel effort, a group called Doctors for America plans to host training sessions for doctors and print posters and brochures for medical waiting rooms.
Skepticism about the law's benefits is widespread. Enroll America's January survey of 1,814 adults found that most people are skeptical they'll be able to find affordable health insurance that covers their needs. When presented with a specific premium amount they might pay, less than a third of respondents felt that the premium was in the affordable range.
"Survey results suggest using a specific premium amount may actually turn away just as many people as it might motivate," according to the survey report on Enroll America's website.
Broader statements - such as "You might be able to get financial help to pay for a health insurance plan" and "If you have a pre-existing condition, insurance plans cannot deny you coverage" - tested better with the survey group.
Enroll America has staff on ground in Texas, Florida, Ohio, Arizona, Michigan, New Jersey, North Carolina and Pennsylvania. It soon will add staff in Illinois and Georgia.
Kicking off the campaign this week, the Get Covered America team and its community partners plan to host more than 50 events in Arizona, Arkansas, California, Delaware, Florida, Georgia, Illinois, Kentucky, Louisiana, Michigan, New Jersey, New Mexico, New York, North Carolina, Ohio, Pennsylvania, Tennessee and Texas.
MIAMI (AP) -- LeBron James led a title-saving charge, and now his crown will be on the line one more time in Game 7.
James powered Miami to a frantic fourth-quarter rally and overtime escape as the Heat beat the San Antonio Spurs 103-100 on Tuesday night to extend the NBA Finals as far as they can go and keep their repeat chances alive.
Losing his headband but keeping his cool while playing the entire second half and overtime, James finished with 32 points, 10 rebounds and 11 assists, making the go-ahead basket with 1:43 remaining in the extra period.
Tim Duncan scored 30 points for the Spurs, his most in an NBA Finals game since Game 1 in 2003, but was shut out after the third quarter. He added 17 rebounds.
Game 7 will be here Thursday, the NBA's first do-or-die game to determine its champion since the Lakers beat the Celtics in 2010.
The Spurs looked headed to a fifth title in five chances when they built a 13-point lead with under 4 minutes left in the third quarter, then grabbed a five-point edge late in regulation after blowing the lead.
But James hit a 3-pointer before Ray Allen tied it with another with 5.2 seconds remaining in regulation.
James was just 3 of 12 after three quarters, the Heat trailing by 10 and frustration apparent among the players and panic setting in among the fans.
Nothing to worry. Not with James playing like this.
He finished 11 of 26, even making a steal after his basket had given Miami a 101-100 edge in the OT.
Before that, he was 12 minutes from hearing the familiar criticisms about not being able to get it done, from having to watch a team celebrate on his home floor again.
Then he changed the game and erased that story.
The Heat, who haven't lost consecutive games since Jan. 8 and 10, had too much defense and way too much James for the Spurs in the final 17 minutes. They are trying to become fourth team to win the final two games at home since the NBA went to the 2-3-2 format for the finals in 1985.
James came in averaging 31.5 points in elimination games, highest in NBA history, according to a stat provided through the NBA by the Elias Sports Bureau.
This wasn't quite the 45-point performance in Game 6 of last year's Eastern Conference finals in Boston, but given the higher stakes may go down as more important - if the Heat follow it with another victory Thursday.
The Heat were in the same place as they were in 2011 at the end of their Big Three's first season together, coming home from Texas facing a 3-2 deficit in the finals.
This is a different team. And oh, what a different James.
They said they welcomed this challenge, a chance to show they how much mentally tougher they were than the team the Dallas Mavericks easily handled in Game 6 that night.
James made sure they did, looking nothing like the player who was so bad in the fourth quarters during that series.
He was simply unstoppable down the stretch of this one.
Kawhi Leonard had 22 points and 11 rebounds for the Spurs. Tony Parker had 19 points and eight assists, but shot just 6 of 23 from the field.
The Spurs had one final chance down 103-100, but Chris Bosh blocked Danny Green's 3-pointer from the corner as time expired.
Bosh had said Green wouldn't get open the way he has all series - and he didn't.