Pharmacy groups protest restrictions on Medicare diabetes education benefit

Pharmacy groups complained to Medicare that many community pharmacies would not qualify to provide diabetes education to Medicare recipients under the proposed rule the agency issued last February. The National Association of Chain Drug Stores, the National Community Pharmacists Association and the American Pharmaceutical Association wrote a joint letter on April 12 to Nancy Ann Min-DeParle, administrator of the Health Care Financing Administration, which runs Medicare. The letter said in part, "The proposed rule establishes strict and unfair limits on the services providers can deliver, including restrictions on eligibility and arbitrary limits on the care providers can offer, while discouraging healthcare providers from providing services in a confidential, one-to-one setting."

The three groups are especially concerned with the requirement in the proposed rule that any provider of diabetes counseling have a dietitian and a certified diabetes educator on staff. Larry Kocot, senior vice president and general counsel at NACDS, said that most retail pharmacies do not use either a dietitian or a CDE to provide counseling. Kocot suggested Medicare cancel that requirement for pharmacies and replace it with one that says pharmacists can do the counseling themselves as long as they pass the National Association of Boards of Pharmacy examination on diabetes.

The Balanced Budget Act of 1997 said Medicare could reimburse for diabetes counseling starting July 1, 1998. On that date, Medicare started reimbursing only physicians who were certified by the American Diabetes Association. Once this proposed rule becomes final, pharmacists and pharmacies that have Medicare numbers because they supply durable medical equipment will also be allowed to receive reimbursement for diabetes counseling as long as they jump through certain hoops.

Medicare wants to pay for 10 visits per patient in the first year with a single visit in the following years. Fees would be $55.41 for a single-patient session and $32.62 when a patient is part of a group. Kocot thinks a patient's primary care physician, in consultation with the patient and the certified provider, should determine the number of hours of education and training the covered beneficiary needs. As for the proposed reimbursement, he called it "inadequate."

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