CMS revises Medicare bidding program for specific devices

The medical technology industry has reacted positively to the recent updates to the US Centers for Medicare & Medicaid Services (CMS) competitive bidding programme (CBP), although some concerns remain. The CMS announced modifications to the CBP targeting durable medical equipment, prosthetics, orthotics, and related supplies (DMEPOS) in a statement released on 28 November.

The CBP for DMEPOS is a mechanism where suppliers compete to provide medical equipment at the most cost-effective rates for Medicare. Among the updates, CMS is introducing a nationwide remote item delivery (RID) CBP for products typically supplied via mail order. The implementation period for these changes has been extended, running from December 2025 to January 2028, instead of the previously planned full rollout by 2027.

CMS also specified that the number of contracts in each product category will be based on 125% of suppliers providing at least 3% of the total national allowed services for the leading item in 2025. Affected product categories include Class II Continuous Glucose Monitors (CGMs) and insulin pumps, urological supplies, ostomy supplies, hydrophilic urinary catheters, and off-the-shelf (OTS) back, knee, and upper extremity braces.

The agency outlined the expected distribution of contracts: approximately ten national suppliers for CGMs and insulin pumps, eight for urological and ostomy supplies, six for OTS upper extremity and knee braces, and four for OTS back braces.

AdvaMed President and CEO Scott Whitaker welcomed the revised implementation timeline and the updated contract structure. Whitaker had previously urged CMS administrator Mehmet Oz in August to address significant issues with the programme. The CBP had been paused in December 2023 due to feasibility concerns arising from the Covid-19 pandemic and industry feedback suggesting the programme was driving prices too low.

One major concern from Whitaker involved patient safety regarding CGMs. CMS now requires contract suppliers to provide the specific brand of CGM or insulin pump prescribed by the physician. Whitaker stated, We welcome CMSs requirement that suppliers furnish the diabetes devices prescribed by physicians, which ensures patients receive technologies that best meet their clinical needs.

Despite supporting the CGM adjustments, AdvaMed remains cautious that the CBP may limit access to essential medical devices. Whitaker emphasized the organisations strong opposition to including ostomy, tracheostomy, and urological supplies in the CBP, highlighting that these are prosthetic devices rather than durable medical equipment and are highly personalised. He warned that disruptions could lead to serious health complications and increased hospitalisation costs.

Author: Sophia Brooks