Medicare Market Shares of Non-Mail Order Diabetes Test Strips From April Through June 2018
WHY WE DID THIS STUDY
The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) prohibits CMS from awarding a Competitive Bidding Program contract to a supplier of diabetes test strips if the supplier's bid does not cover at least 50 percent, by volume, of the types of diabetes test strips provided to Medicare beneficiaries. This is known as the "50-percent rule." MIPPA requires OIG to determine the market shares of the types of diabetes test strips before each round of competitive bidding to assist CMS in ensuring that bidding suppliers meet the 50-percent rule. Initially, compliance with the 50 percent rule was assessed using mail order claims only. The Bipartisan Budget Act of 2018 amended the 50-percent rule by requiring that, for bids on or after January 1, 2019, CMS must use data from the non-mail order Medicare market as well as the mail-order one. Since 2010, OIG has been conducting evaluations of the Medicare market shares of diabetes test strips provided via mail order. This is the first OIG evaluation of Medicare market shares for diabetes test strips provided via non-mail order.
HOW WE DID THIS STUDY
We determined the Medicare market shares for diabetes test strips types associated with a simple random sample of Medicare claims for the 3-month period of April 1, 2018, through June 30, 2018. Our sample of 1,210 claims was drawn from a population of 1,598,926 claims for diabetes test strips provided via non-mail order to Medicare beneficiaries. These 1,210 claims were submitted by a total of 1,192 suppliers of non-mail order diabetic test strips. Of the 1,192 suppliers associated with our sampled claims, 1,143 responded, a 96 percent response rate by suppliers.
WHAT WE FOUND
From April through June 2018, sampled suppliers provided 34 types of diabetes test strips via the Medicare National Mail-Order Program. The top 3 strip types accounted for 53 percent of the Medicare mail-order market, and the top 10 strip types accounted for 93 percent of the market.