competitive bidding program external aade...medicare considers an insulin pump to be durable medical...

Competitive Bidding Program External

Infusion Pumps and Supplies-

Issues with Supplier Compliance

Impacting Beneficiary Access to Insulin

Pumps and Related Supplies

December 2014

AADE

200 W. Madison Street, Suite 800

Chicago, IL 60606

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EXECUTIVE SUMMARY

Diabetes is a chronic condition affecting over 29 million Americans, many of whom may be

going undiagnosed. Nearly 5 percent of persons with diabetes have Type 1 diabetes in which

their body cannot produce insulin and thus cannot regulate their amount of blood sugar.

Persons with Type 1 diabetes require a lifetime of treatment including insulin therapy. While a

majority of people with Type 1 diabetes inject themselves with insulin, often several times a

day, many other people with Type 1 diabetes use an external insulin infusion pump to provide

continuous insulin infusion therapy.

Because of the chronic and progressive nature of diabetes, complications of diabetes become

progressively more and more severe. Cardiovascular disease and diabetic neuropathy are

common complications.

Diabetes is responsible for more than $176 billion in U.S. health care expenses. With nearly

27 percent of the Medicare aged population estimated to have diabetes1, the Medicare program

bears an extensive share of this cost. While estimates of the prevalence of Type 1 diabetes in

the Medicare population are imprecise, some have estimated that between 5 and 10 percent of

the total patient population with diabetes may have Type 1 diabetes.2

In order to help manage Medicare spending, Congress required the Centers for Medicare &

Medicaid Services to establish the Durable Medical Equipment, Prosthetics, Orthotics and

Supplies Competitive Bidding Program (CBP). The program was designed to contain

Medicare spending by applying market driven prices determined through an open bidding

process. In creating the CBP, Congress expected to reduce overall spending without impacting

beneficiary access to items.

While the program is saving money, it may be having unintentional negative impacts on

Medicare beneficiary access to insulin pumps and related supplies. The AADE conducted a

survey of participating Medicare DMEPOS suppliers, and found the following:

Many contract suppliers do not make available insulin pumps and their associated

replacement supplies; and

Among those contract suppliers who do offer insulin pumps and replacement supplies,

many do not offer more than one brand.

1 Day HR, Parker JD. Self-report of diabetes and claims-based identification of diabetes among Medicare beneficiaries. National health statistics

reports; no 69. Hyattsville, MD: National Center for Health Statistics. 2013. 2 http://www.diabetes.org/diabetes-basics/type-1/

http://www.diabetes.org/diabetes-basics/type-1/

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These findings suggest potential access problems for beneficiaries. Contract suppliers are

obligated to offer each HCPCS code in the product category. Many of the contract suppliers

are not offering insulin pumps and associated supplies, and so are not complying with this

requirement. Beneficiaries seeking insulin pumps or replacement supplies may have difficulty

finding a contract supplier that furnishes these items. Moreover, beneficiaries may find it

difficult to locate a contract supplier capable of furnishing replacement supplies that work with

the insulin pump system used by the beneficiary.

These findings also raise concerns with the prospect of expansion of competitive bidding for

insulin pumps and supplies to areas outside of the original 9 Competitive Bidding Areas.

CMS can resolve these problems by making modest changes to the DME CBP. First, CMS

should immediately enforce the requirement that contract suppliers make available all HCPCS

codes within the product category to increase the number of suppliers from which a beneficiary

can obtain insulin pumps and replacement supplies. Second, in order to ensure that suppliers

are encouraged to carry the full range of products, in future bidding rounds, insulin pumps and

related supplies should be removed from the current product category “External Infusion

Pumps and Supplies” and included in a new product category “Continuous Insulin Infusion

Systems and Supplies.”

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ABOUT THE AMERICAN ASSOCIATION OF DIABETES EDUCATORS

Founded in 1973, AADE is a multi-disciplinary professional membership organization

dedicated to improving diabetes care through education. With more than 13,000 professional

members including nurses, dietitians, pharmacists, and others, AADE has a vast network of

practitioners involved in the daily treatment of diabetes patients.

Diabetes educators are licensed health care professionals—registered nurses, registered

dietitians and pharmacists, among others—who specialize in helping people with diabetes

understand how to best manage their health.

BACKGROUND

Diabetes is a chronic medical condition that affects the body’s ability to regulate blood sugar

levels. The Centers for Disease Control and Prevention estimate that more than 29 million

Americans may have diabetes and that nearly 8 million of those American may be going

undiagnosed.3 Diabetes presents an increased risk of cardiovascular disease, neuropathy,

vision problems, and many other comorbidities.

The vast majority of persons with diabetes have Type 2 diabetes in which the body does not

produce enough insulin (or is unable to react to insulin) and cannot properly regulate blood

sugar levels. Most persons with Type 2 diabetes can treat their condition through a

combination of diet, exercise, and if needed, medication and insulin.

By contrast, for the 5 percent of persons with Type 1 diabetes, the body is unable to produce

insulin. Persons with Type 1 diabetes must follow strict dietary regimens, routinely monitor

their blood glucose levels and use insulin for the rest of their life.4

It is generally acknowledged that diabetes and related complications are a significant

contributor to overall healthcare spending. The total estimated cost of diagnosed diabetes in

2012 is $245 billion, including $176 billion in direct medical costs and $69 billion in reduced

productivity.5

While it is difficult to quantify the precise percentage of Medicare patients with diabetes, some

have estimated that anywhere between 20% - 40% of the Medicare population may be affected

3 http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf 4 http://www.diabetes.org/diabetes-basics/ 5 “Economic costs of diabetes in the U.S. in 2012” Diabetes Care. 2013 Apr;36(4):1033-46

http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf

http://www.diabetes.org/diabetes-basics/

http://www.ncbi.nlm.nih.gov/pubmed/23468086?dopt=Abstract

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by the condition.6 The CDC estimates that among U.S. residents aged 65 years and older, 10.9

million, or 25.9%, had either Type 1 or Type 2 diabetes in 2012.7 The National Center for

Health Statistics estimates that 5 to 10 percent of all persons, not only persons with Medicare,

with diabetes have Type 1 diabetes.8

In 2011, CMS estimated that 1 out of every 3 Medicare dollars is spent on diabetes, with a high

percentage attributed to tertiary illness caused by unmanaged or undermanaged diabetes.9

Persons with diabetes tend to account for higher Medicare per beneficiary spending, with 33.1

percent of the population of persons with diabetes having 2004 Part B expenses over $3,000

compared to 22.2 percent of persons without diabetes.

Because persons with Type 1 diabetes are unable to produce insulin, they must have insulin

artificially delivered. The vast majority of patients are able to use injected insulin; however,

some have estimated that between 150,000 and 300,000 patients are unable to self-inject and

must use a pump to deliver continuous subcutaneous insulin infusion (CSII) therapy.10,11 A

normally functioning pancreas releases insulin into the bloodstream throughout the day. The

use of an insulin pump allows users to achieve the same results as they would if their pancreas

functioned normally. For those persons with Type 1 diabetes who cannot properly measure

insulin into a syringe, who cannot self-inject insulin, or for those for whom insulin injections

do not adequately control blood sugar levels, a pump provides an effective alternative. The

benefits of CSII are well documented and include lower HbA1C levels.12 Additionally, CSII

has been shown to provide more favorable glycemic control without increased risk of

hypoglycemia in adults with Type 1 diabetes.13

The Medicare program provides coverage of CSII for persons who have “completed a

comprehensive diabetes education program, and have been on a program of multiple daily

injections of insulin (i.e., at least 3 injections per day), with frequent self-adjustments of insulin

doses for at least 6 months prior to initiation of the insulin pump, and has documented

frequency of glucose self-testing an average of at least 4 times per day during the 2 months

6 Source: AHRQ http://www.effectivehealthcare.ahrq.gov/tasks/sites/ehc/assets/File/Data-Points_1_Diabetic-Foot-

Ulcers_Data_02-2011.pdf 7 Centers for Disease Control and Prevention. (2011). National Diabetes Statistics Report, 2014. Retrieved from

http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf 8 Ibid. 9 Centers of Medicare and Medicaid Services. (2011). Medicare Healthcare Support Overview. Retrieved from

https://www.cms.gov/CCIP/ 10 Clinical Diabetes April 2007 vol. 25 no. 2 41-42 11 Chait, Jan. "Insulin Pumps Not Just for Type 1." Diabetes Self Management. N.p., 20 June 2014. Web. 5 Dec.

2014. 12 Diabetes Technol Ther. 2014 Oct 15 13 Ann Intern Med. 2012 Sep 4;157(5):336-47.)

https://www.cms.gov/CCIP/

http://www.ncbi.nlm.nih.gov/pubmed/25317602

http://www.ncbi.nlm.nih.gov/pubmed/22777524

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prior to initiation of the insulin pump,” and who meet a number of other clinical criteria.

Medicare also provides coverage of CSII for patients who used “a pump prior to enrollment in

Medicare and have documented frequency of glucose self-testing an average of at least 4 times

per day during the month prior to Medicare enrollment.”14 These patients must still meet

additional lab testing criteria required by CMS as well as the NCD for CSII.

Medicare considers an insulin pump to be durable medical equipment (DME); that is, a device

that is inherently medical in nature and can withstand repeated use. Typically, DME, including

insulin pumps, is considered to have a 5 year usable lifetime15 and can only be replaced during

that time when the item is irreparably damaged.16

Background of DME Competitive Bidding

Section 302(b)(1) of the MMA (Pub. L. 108–173), as amended by section 154 of

MIPPA (Pub. L. 110-275), amended section 1847 of the Social Security Act to require

the Secretary to establish and implement programs under which competitive bidding

areas (CBAs) are established throughout the United States for contract award purposes

for the furnishing of certain competitively priced items for which payment is made

under Medicare Part B (the “Medicare DMEPOS Competitive Bidding Program”).

Medicare’s DMEPOS Competitive Bidding Program (CBP) has five main objectives:

1. To implement CBPs for certain DMEPOS items.

2. To assure beneficiary access to quality DMEPOS as a result of the

program.

3. To reduce the amount Medicare pays for DMEPOS and create a payment

structure under competitive bidding that is more reflective of a competitive

market.

4. To limit the financial burden on beneficiaries by reducing their out-of

pocket expenses for DMEPOS they obtain through the program.

5. To contract with suppliers that conduct business in a manner that is

beneficial for the program and for Medicare beneficiaries.17

14 “National Coverage Determination (NCD) for Infusion PUMPs (280.14)”; Medicare National Coverage

Determinations Manual, Pub. 100-3, Sec.280.14 15 42 C.F.R. 414.201(f)(1) 16 42 C.F.R. 414.210(e)(4) 17 “Medicare Program; Competitive Acquisition for Certain Durable Medical Equipment, Prosthetics, Orthotics, and

Supplies (DMEPOS) and Other Issues”; 72 Fed. Reg. 17,997 (04/10/2007)

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With limited exceptions, Medicare beneficiaries who maintain their permanent

residence in a CBA must obtain competitively bid items from a contract supplier within

the CBA.18 Additionally, contract suppliers must furnish the items in their contract to

all beneficiaries who maintain a permanent residence in the CBA, or who visit the

CBA, and who request the items from them unless one of a very narrow set of

exceptions applies.19

In order to better organize the CBP, CMS grouped similar products into product

categories. Each product category contains a number of HCPCS codes each of which

describes the products included within the category.20 Winning suppliers are required

to supply all of the HCPCS codes in the product category in which they are awarded a

contract.21

The product category “External Infusion Pumps and Supplies” includes the following

fourteen HCPCS Codes: Figure 1

Table Source: CMS DMEPOS Competitive Bidding Program, Round 1 Recompete, Product Categories and HCPCS

Codes,

http://www.dmecompetitivebid.com/Palmetto/Cbicrd1Recompete.Nsf/files/R1RC_HCPCS_Codes.pdf/$File/R1RC_HCPCS_Codes.pdf;

Accessed November 12, 2014.

CMS has established distinct HCPCS codes for insulin pumps and ambulatory drug

18 Id., at 18,007 19 Id., at18,026 20 Id., at 18,029 21 Medicare regulations provide, “A contract supplier must agree to furnish items under its contract…” and “For

each product category that a supplier is seeking to furnish under a competitive bidding program, the supplier must

submit a separate bid for each item in that product category.” 42 C.F.R. § 414.422(e)(1) and §414.412(d),

respectively

http://www.dmecompetitivebid.com/Palmetto/Cbicrd1Recompete.Nsf/files/R1RC_HCPCS_Codes.pdf/$File/R1RC_HCPCS_Codes.pdf

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infusion pumps, but CMS did not distinguish between replacement supplies for insulin

pumps and ambulatory drug infusion pumps, specifically with respect to replacement

catheters (A4221). While replacement reservoirs for insulin pumps have a code

(K0552, sterile syringe type cartridges) that is different from the code for replacement

reservoirs for ambulatory drug infusion pumps (A4222, Infusion supplies for external

drug infusion pump, per cassette or bag), all replacement catheters in Medicare share

the same HCPCS code, based on Medicare coding instructions. That is, the code

A4221 describes catheters used for both drug infusion pumps and insulin pumps, even

though the catheters used for each pump type are very different.

Each insulin pump delivery system is unique. Each brand’s replacement parts, like the

reservoirs described by K0552 and tubing described by A4221, are specifically

designed to be compatible only with that brand’s pump system; they are not

interchangeable with other pump systems. Because of the unique nature of pumps and

their replacement supplies, in order to assure access, it is important suppliers in each

CBA carry and be able to provide each brand of replacement supplies to supply the

need in that particular CBA. If a CBA does not have adequate access to all brands of

supplies, beneficiaries may find they are unable to obtain the needed brand of

replacement supply. If a beneficiary uses a Medtronic pump system, for example, it is

of little use to the beneficiary that a supplier carries Animas or Roche replacement

supplies. If the beneficiary is unable to find a supplier who can furnish Medtronic

compatible replacement supplies in the CBA, the beneficiary effectively does not have

access to replacement supplies, unless the beneficiary changes pump system brands.

Unlike blood glucose meters, which are relatively inexpensive, and often provided by

suppliers at a discount to encourage beneficiary switching, insulin pumps are subject to

the requirements of the capped rental category, and typically may not be replaced more

than once every five years. This makes switching insulin pump brands difficult and

underscores the need to assure that patients who use insulin pumps have access to the

appropriate brand of supplies for their pump throughout the entire capped rental period.

OBJECTIVE

The American Association of Diabetes Educators conducted this study to assess the

performance of the CBP for insulin pumps and replacement supplies, and Medicare

beneficiary access to insulin pumps and related supplies in Competitive Bidding Areas.

METHODOLOGY

Members of the American Association of Diabetes Educators surveyed winning

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suppliers listed on the www.medicare.gov website as of January 16, 2014. Surveys were

conducted in the fall of 2014. Surveyors were furnished with a list of contract suppliers

and contact information. The list of suppliers surveyed may be found at Appendix A to

this report.22

Using the Medicare Supplier Directory (MSD) on Medicare.gov, beneficiaries can

identify Contract Suppliers authorized to furnish external infusion pumps, including

insulin pumps, and related supplies, and identify the products purported to be offered

by and available through the suppliers. For purposes of the survey, we tallied the

specific brands and models listed in the MSD as of January 2014 as being offered by

each supplier. Because suppliers in the CBP will often change, we again queried the

MSD in November 2014 as an additional verification step. We used this listing as a

baseline against which we compared the brands and models actually being offered by

each supplier, and noted discrepancies.

Due to a concern that beneficiaries in the Miami CBA were finding it difficult to locate

an experienced supplier of insulin pumps, AADE surveyors attempted to contact each

supplier in the Miami CBA. All but one supplier in the Miami CBA responded. In

other regions, a random sample of winning suppliers was contacted. For suppliers who

operated in multiple regions we limited the number of times that supplier was

contacted, if the contact information was same for all regions, to avoid

multiple/duplicate unnecessary calls.

For each survey, the surveyor contacted the contract supplier, identified himself/herself

as a diabetes educator and inquired about the availability of specific brands and models

of insulin pumps and replacement supplies. If the supplier confirmed that the product

was available, the surveyor noted that on the survey. If the supplier reported that the

product was not available, the surveyor inquired as to whether the supplier ever carried

that brand and about reasons why that product was not available. Surveyors sought to

validate product availability by asking whether a product is available for immediate

shipment, and if not when the product would be available to be shipped. Surveyors also

asked if product other than that listed on MSD was available. The survey instrument can be

found at Appendix B to this report.

Responses were documented using a Microsoft Excel spreadsheet that contained fields

for surveyors to populate for each supplier. Surveyors recorded open-ended responses

in separate fields in the spreadsheet.

22 Ibid.

http://www.medicare.gov/

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FINDINGS

During the course of this study, a total of 29 different suppliers were contacted across the

nine MSAs included in the CBA. Of these 29 different suppliers only 17 reported

carrying insulin pumps and 18 reported carrying replacement supplies and reservoirs.

Since the time these suppliers were contacted, additional suppliers are listed in the

Medicare Supplier Directory and some of these additional supplier report carrying insulin

pumps and replacement suppliers. However, there are still a number of suppliers who do

not carry these products.

Many Contract Suppliers Do Not Stock Insulin Pumps (E0784), Replacement Supply Kits

(A4221) and Reservoirs (A4222)

Despite the requirement23 that winning suppliers carry all HCPCS codes within a product

category, many contract suppliers are not providing all of the HCPCS codes in the “infusion

pump” product category. Specifically, AADE found that many contract suppliers in each of

the CBAs do not carry insulin pumps and/or related supplies.

For example, in the Charlotte, NC CBA, AADE surveyors contacted 10 suppliers and of those

10, only 5 reported that they carried insulin pumps.

Our surveyors found the same results in other CBAs as well. In the Kansas City CBA, we

contacted 5 winning suppliers and found that only 1 of the 5 carried insulin pumps. In the

Cleveland, OH CBA, of the 8 suppliers we surveyed, only 1 reported that it carried insulin

pumps. And in the Miami CBA our surveyors contacted 13 suppliers, and found that only 8

reported carrying insulin pumps.

Of the 10 suppliers surveyed in the Charlotte, NC CBA, 6 reported carrying insulin pump

replacement catheters and reservoirs. In the Kansas City CBA, we interviewed 5 of the 12

winning suppliers and found that only 1 of the 5 we interviewed carries replacement catheters

and reservoirs. In Miami, of the 13 suppliers we contacted, 8 carry replacement catheters and

reservoirs.

23 Ibid

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Figure 2

CBA Number of

Suppliers

Interviewed

Number of

Suppliers with

Pumps

Number of

Suppliers with

Replacement

Supplies

Charlotte, NC 10 5 6

Kansas City, MO 5 1 1

Cleveland, OH 8 1 1

Miami, FL 13 8 8

Many Contract Suppliers Do Not Carry an Adequate Variety of Insulin Pump (E0784) Brands,

Replacement Kits (A4221), and Reservoirs (A4222)

The Food and Drug Administration approves ambulatory insulin pumps under the 510(k) pre-

market notification process or the Pre-Market Approval (PMA) process. FDA maintains a

database of devices approved under 510(k) and the PMA processes. There are currently only

four brands of pumps on the market in the U.S.: Animas, Medtronic, Roche and Tandem.

Our survey found that of the limited number of suppliers that reported carrying insulin pumps,

fewer still carry a choice of brands of insulin pumps.

In the Charlotte CBA, only 2 of the 5 suppliers carrying insulin pumps carry all 4 brands, 2 of

the suppliers carry 2 or 3 brands and one supplier carries only a single brand of insulin pump.

In the Cleveland CBA, the single supplier of insulin pumps carries all four brands. In Kansas

City, the single supplier that reporting carrying insulin pumps carries only a single brand.

And in Miami, only 1 of the 8 suppliers with insulin pumps carries more than a single brand

of pump.

Figure 3

Our evaluation of the availability of replacement supplies found similar trends. HCPCS code

A4221 describes replacement supplies used with ambulatory infusion pumps and insulin

pumps, and HCPCS code K0552 describes reservoirs used by ambulatory infusion pumps and

insulin pumps. Neither code differentiates between supplies for an ambulatory infusion pump

CBA Suppliers with Only

1 Pump Brand

Available

Suppliers with 2 or

3 Pump Brands

Available

Suppliers with All 4

Pump Brands

Available

Charlotte, NC 1 2 2

Cleveland, OH 0 0 1


Miami, FL 7 1 0

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and an external insulin pump. Supplies for the types of pumps are not interchangeable and

neither are the supplies designed for specific brands and models of pumps. For example,

tubing and reservoirs compatible with Medtronic brand pumps cannot be used with Animas

brand pumps.

In the Charlotte CBA, of the 6 suppliers carrying replacement supplies, only 2 suppliers

reported carrying replacement supplies for all 4 brands of insulin pumps; 1 suppliers reported

supplies for 2 brands and 3 suppliers reported carrying only 1 brand. In Cleveland, only 1

supplier reported carrying replacement supplies, although that supplier does report carrying a

robust selection of brands. In Kansas City, the lone supplier of replacement supplies carries

only a single brand of replacements. In Miami, only 1 of 8 suppliers carries more than 2

different brands of replacements.

Figure 4

CONCLUSIONS

Based on these findings, the AADE concludes that beneficiary access to insulin pumps and

replacement supplies is being negatively impacted. Many suppliers are not meeting their

obligation to provide the items within the product category. To the extent that only a small

number, and in some CBAs, only one of contract suppliers are carrying insulin pumps and

replacement supplies, the program is restricting beneficiary access to insulin pumps and

supplies. Beneficiaries may have a difficult time finding the limited number of suppliers that

carry these items. Moreover, it is unclear, but unlikely, that these few suppliers can adequately

fulfill beneficiary demand, especially if CMS based its demand projections on the assumption

that all contract suppliers would be furnishing insulin pumps and replacement supplies.

Beneficiary access also is harmed if they are unable to find replacement supplies that are

compatible with their pump system. Market share for these pump systems varies, but some

pump systems account for a substantial percentage of market share. It is important that

contract suppliers carry replacement supplies for the pump systems used by Medicare

beneficiaries. Because of the high cost of insulin pumps, the stringent policies on the

CBA Suppliers with Only

1 Brand of Supplies

Available

Suppliers with 2 or

3 Brands of

Supplies Available

Suppliers with All 4

Brands of Supplies

Available

Charlotte, NC 3 1 2

Cleveland, OH 0 0 1


Miami, FL 7 1 0

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replacement of pumps, and Medicare coverage limits, beneficiaries are not able to easily

switch to a new pump system. As such, it is important that contract suppliers carry a wide

range of pump system replacement supplies.

It also is important that Medicare beneficiaries have access to a wide range of pumps when it

comes time to purchase a new pump. The CBP was intended to reduce Medicare

expenditures, but to do so without compromising beneficiary access to products. To the

extent that certain insulin pumps are not available through contract suppliers, the CBP is

limiting beneficiary choice and access.

This report raises significant concerns about access to these products if the CBP is eventually

expanded beyond the current 9 CBAs. When CMS expands competitive bidding for insulin

pumps, and if it is expanded without the changes recommended in this report, the access

problems being encountered will be compounded. Beneficiaries throughout the country will

no longer have access to their pumps and supplies through their current supplier, and some

may find that their brand of pump and supply is simply unavailable in their area.

RECOMMENDATIONS

CMS can resolve these problems by making modest changes to the DME CBP.

First, CMS should immediately enforce the requirement that contract suppliers make available

all HCPCS codes within the product category to increase the number of suppliers from which

a beneficiary can obtain insulin pumps and replacement supplies. If contract suppliers fail to

meet these requirements, they should be appropriately disciplined under the provisions of the

CBP, including removal from the program. If an insufficient number of contract suppliers are

available in a CBA to meet beneficiary need for insulin pumps and replacement supplies,

CMS should consider contracting with additional qualified suppliers in order to meet

beneficiary need. CMS may also consider the need to suspend or remove insulin pumps and

supplies from the CBA until such time as access can be restored.

Second, in order to ensure that suppliers are encouraged to carry the full range of products, in

future bidding rounds, insulin pumps and related supplies should be removed from the current

product category “Infusion Pumps” and included in a new product category “Continuous

Insulin Infusion Systems and Supplies.” Redefining the product category in this manner

would allow suppliers that intend to furnish insulin pump products to bid only on those

products. It would also be consistent with changes CMS has previously made to product

categories during the Round 2 Recompete. As a part of the Round 2 Recompete, CMS

combined the Oxygen and CPAP Devices/Respiratory Assist Devices product categories into

a single product category; combined the Walkers and Wheelchairs/Scooters categories into a

Page | 13

single product category; created a new General Home Equipment category that includes the

previous Hospital Beds and Support Surfaces categories in addition to new products; added a

new TENS devices product category; and created categories for nebulizers and Negative

Pressure Wound Therapy devices.

As a part of the redefinition of the product category, CMS should consider using the existing

insulin pump specific HCPCS codes in order to differentiate between insulin pumps and drug

infusion pumps, replacement kits and supplies. Without using the existing series of HCPCS

codes for insulin pumps (E0784) and supplies (A4230 – A4232) bidding on an “Continuous

Insulin Infusion Systems and Supplies” product category will be complicated, insofar as

bidders may not be able to clearly account for the differences in costs between insulin pumps

and drug infusion pumps as they prepare their bids.

CONTACTS

For more information about AADE or this study, please contact:

James E. Specker, MBA MIS

Director, Federal and State Advocacy

American Association of Diabetes Educators

[email protected]

mailto:[email protected]

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Appendix A

Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)

Competitive Bidding Program • Round 1 Recompete

Contract Supplier List: Product Category External Infusion Pumps and Supplies

Legal Business Name /

Doing Business As Name

Address Phone Number(s)

Charlotte-Gastonia-Rock Hill, NC-SC 1 ADVANCED HOME CARE, INC. /

ADVANCED HOME CARE

2520 WHITEHALL PARK DR STE 950

CHARLOTTE, NC 28273

(704) 831-5000

2 CAROLINAS MEDICAL CENTER

AT HOME, LLC / HEALTHY AT

HOME CMC HOME INFUSION A

1601 ABBEY PL SUITE 110

CHARLOTTE, NC 28209

(704) 512-5333

3 CORAM ALTERNATE SITE

SERVICES, INC. / CORAM

ALTERNATE SITE SERVICES INC

9401 SOUTHERN PINE BLVD

CHARLOTTE, NC 28273

(800) 522-0157 (704)

523-7731

4 DIABETES MANAGEMENT AND

SUPPLIES / DIABETES MGT &

SUPPLIES

10 COMMERCE CT STE B

NEW ORLEANS, LA 70123

(888) 738-7929

5 EDWARDS HEALTH CARE

SERVICES, INC. / DIRECT

HEALTHCARE SUPPLY

5640 HUDSON INDUSTRIAL PKWY

HUDSON, OH 44236

(888) 344-3434 (888)

344-3434

6 HOME INFUSION SOLUTIONS,

LLC / HOME SOLUTIONS

8701 PARK CENTRAL DRIVE SUITE

600

RICHMOND, VA 23227

(804) 767-3600

7 HOMECHOICE PARTNERS INC /

HOMECHOICE PARTNERS

160 CONGRESS BLVD SUITE D

DUNCAN, SC 29334

(888) 865-1110 (864)

583-8190


HOMECHOICE PARTNERS INC

2300 ENGLERT DR A DURHAM, NC

27713

(866) 997-7289 (866)

997-7589



2700 BREEZEWOOD AVE

FAYETTEVILLE, NC 28303

(877) 260-2658 (910)

483-2155

1

0

HOMECHOICE PARTNERS INC /


5365 ROBIN HOOD RD SUITE 200

NORFOLK, VA 23513

(800) 745-7764 (757)

855-4255

1

1

INFUSYSTEM, INC. /

INFUSYSTEM

31700 RESEARCH PARK DR

MADISON HEIGHTS, MI 48071

(800) 962-9656 (248)

291-1210

1

2

LIBERTY MEDICAL SPECIALTIES,

INC / LIBERTY MEDICAL

SPECIALTIES INC

612 10 JEFFERSON ST WHITEVILLE,

NC 28472

(910) 642-2250

1

3

LIBERTY MEDICAL SPECIALTIES,

INC / LIBERTY MEDICAL

SPECIALTIES INC

813 EAST ROOSEVELT BLVD STE H

MONROE, NC 28112

(704) 238-0027

1

4

LINCARE INC. / ADULT &

PEDIATRIC SPECIALIST

5104 REAGAN DR STE 9

CHARLOTTE, NC 28206

(800) 333-8465 (704)

598-5014

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1

5

LINCARE INC. / LINCARE 2502 LOWELL RD GASTONIA, NC

28054

(877) 868-4424 (704)

824-3009

1

6

LINCARE INC. / LINCARE INC 1262 25TH STREET SEPL HICKORY,

NC 28602

(866) 304-4441 (828)

304-4441

1

7

LINCARE INC. / LINCARE INC 1969 OLD CHARLOTTE HWY SUITE

H J K

MONROE, NC 28110

(877) 282-9996 (704)

225-9996

1

8

LINCARE INC. / LINCARE INC 535 PITTS SCHOOL RD NW STE A

CONCORD, NC 28027

(888) 297-0385 (704)

782-0385

1

9

LINCARE INC. / LINCARE INC 746 N 2ND ST STE A2

ALBEMARLE, NC 28001

(877) 807-5629 (704)

986-4342

2

0

LINCARE INC. / LINCARE INC

DBA CAROLINA INFUSION C

13504 S POINT BLVD STE H

CHARLOTTE, NC 28273

(866) 583-2140 (704)

583-2140

2

1

LINCARE INC. / LINCARE, INC. 200 EAST ARROWHEAD DR STE O-1

CHARLOTTE, NC 28213

(800) 291-7111 (704)

596-1719

2

2

MEDICAL COMFORT SYSTEMS /

MEDICAL COMFORT SYSTEM

1654 KATY LANE FORT MILL, SC

29708

(800) 765-4697 (803)

396-8050

2

3

NUFACTOR, INC / NUFACTOR

INC

41093 COUNTY CENTER DR B

TEMECULA, CA 92591

(800) 323-6832 (800)

323-6832

2

4

OPTION CARE ENTERPRISES INC

/ WALGREENS INFUSION

SERVICES

1015 AVIATION PKWY SUITE 700

MORRISVILLE, NC 27560

(800) 879-6137 (919)

481-9696

2

5

TRIAD MEDICAL SUPPLY LLC /

INFUCARE, A DIVISION OF TRIAD

MEDIC

599 HIGHLAND COLONY PARKWAY

STE 110

RIDGELAND, MS 39157

(601) 605-1699

Cleveland-Middletown, OH-KY-IN 1 CORAM ALTERNATE SITE



4305 MULHAUSER RD STE 1

FAIRFIELD, OH 45014

(800) 523-1435 (513)

874-1161



SPECIALTY INFUSION SERVICES

11711 N COLLEGE AVE STE 125

CARMEL, IN 46032

(800) 821-9150 (317)

819-4900

3 CORNERSTONE MEDICAL

SERVICES- MIDWEST LLC /

CORNERSTONE MEDICAL

SERVICES

4460 LAKE FOREST DR STE 232

BLUE ASH, OH 45242

(513) 554-0222



SUPPLIES



(888) 738-7929

5 HEALTH CARE SOLUTIONS AT

HOME INC. / HEALTH CARE

SOLUTION

310 GARGRAVE RD

W CARROLLTON, OH 45449

(937) 866-8413



SOLUTIONS

3478 HAUCK RD BLDG 2

CINCINNATI, OH 45241

(513) 271-5115

Page | iii

7 INFUSYSTEM, INC. /

INFUSYSTEM



(800) 962-9656 (248)

291-1210

8 LINCARE INC. / LINCARE INC 10720 MAKRO DR STE A

CINCINNATI, OH 45241

(800) 309-3050 (513)

272-6050

9 LINCARE INC. / LINCARE INC 11 SPIRAL DR STE 6

FLORENCE, KY 41042

(800) 306-3299 (859)

525-0202

1

0

LINCARE INC. / LINCARE INC 2003 SPRINGBORO WEST RD

MORAINE, OH 45439

(800) 414-8599 (937)

299-1141

1

1

LINCARE INC. / LINCARE INC 2514 REGENCY RD STE 103

LEXINGTON, KY 40503

(859) 278-7700

1

2

LINCARE INC. / LINCARE INC 3020 N SHUN PIKE RD MADISON, IN

47250

(800) 688-3877 (812)

265-4377

1

3

LINCARE INC. / LINCARE INC 5694 SHEPHERDSVILLE RD

LOUISVILLE, KY 40228

(502) 515-3500

1

4

LINCARE INC. / LINCARE INC 8765 GUION RD STE E

INDIANAPOLIS, IN 46268

(800) 906-0050 (317)

870-2090

1

5

LINCARE INC. / LINCARE INC. 231 W MAIN STREET STE C

HILLSBORO, OH 45133

(937) 393-1400

1

6


INC


TEMECULA, CA 92591

(800) 323-6832 (800)

323-6832

1

7



SERVICES

50 W TECHNE CENTER DR STE J

MILFORD, OH 45150

(800) 879-6137 (513)

576-8400

Cleveland-Elyria-Mentor, OH 1 ADVANCED INFUSION SERVICES

LTD / ADVANCED INFUSION

SERVICES

160 OPPORTUNITY PKWY STE 102

AKRON, OH 44307

(330) 972-3311

2 CARING SOLUTIONS INC /

CARING SOLUTIONS INC

220 E BUCYRUS ST CRESTLINE, OH

44827

(800) 683-9302 (419)

683-3502




6565 DAVIS INDUSTRIAL PKWY

STE AA

SOLON, OH 44139

(800) 826-2174 (440)

836-8900



SUPPLIES



(888) 738-7929



SOLUTIONS

1130 LAKE AVE ASHTABULA, OH

44004

(866) 627-7697 (440)

964-5150



SOLUTIONS

1210 KELLY AVE UNIT A

AKRON, OH 44306

(800) 227-2152 (330)

724-7586



SOLUTIONS

9885 ROCKSIDE RD STE 150

CLEVELAND, OH 44125

(888) 458-4321 (216)

901-9250

Page | iv



SOLUTIONS AT HOME INC

31390 INDUSTRIAL PKWY NORTH

OLMSTED, OH 44070

(888) 470-7929 (440)

777-4400


INFUSYSTEM



(800) 962-9656 (248)

291-1210

1

0

KAUP PHARMACY, INC. / KAUP

PHARMACY

110 E BUTLER ST

FORT RECOVERY, OH 45846

(800) 686-2314 (419)

375-2323

1

1

KAUP PHARMACY, INC. / KAUP

PHARMACY/DEPENDABLE HOME

MEDIC

1201 COMMERCE ST

FORT RECOVERY, OH 45846

(866) 526-0976 (419)

375-7007

1

2

LINCARE INC. / AMERICA'S BEST

MEDICAL EQUIPMENT

1566 AKRON PENINSULA RD STE 2

AKRON, OH 44313

(800) 383-5303 (330)

928-0884

1

3

LINCARE INC. / LINCARE INC 1501 MILAN RD STE 2

SANDUSKY, OH 44870

(800) 210-3375 (419)

621-7380

1

4

LINCARE INC. / LINCARE INC 2167 MENTOR AVE STE 2

PAINESVILLE, OH 44077

(888) 352-4361 (440)

352-4361

1

5

LINCARE INC. / LINCARE INC 2549 S RIDGE RD E ASHTABULA,

OH 44004

(800) 349-9945 (440)

964-6683

1

6

LINCARE INC. / LINCARE INC 4650 W 160TH ST CLEVELAND, OH

44135

(216) 265-3039

1

7

LINCARE INC. / LINCARE INC 620 E SMITH RD STE W25

MEDINA, OH 44256

(866) 314-9805 (330)

723-9805

1

8

LINCARE INC. / LINCARE INC. 9545 MIDWEST AVE UNIT F

GARFIELD HEIGHTS, OH 44125

(800) 695-4633 (216)

581-9649

1

9


INC


TEMECULA, CA 92591

(800) 323-6832 (800)

323-6832

2

0



SERVICES

50 W TECHNE CENTER DR STE J

MILFORD, OH 45150

(800) 879-6137 (513)

576-8400

2

1

SEELEY MEDICAL OXYGEN CO /

SEELEY MEDICAL

1160 GEORGE WASHINGTON BLVD

STE H

AKRON, OH 44312

(800) 473-3539 (330)

733-0996

2

2


SEELEY MEDICAL

900 E 222ND ST EUCLID, OH 44123 (800) 473-3539 (216)

289-7424

2

3

UNIVERSITY HOSPITALS HOME

CARE SERVICES INC /

UNIVERSITY HOSPITALS HOME

CARE SERV

4510 RICHMOND RD

WARRENSVILLE HEIGHTS, OH

44128

(216) 765-1797

Dallas-Fort Worth-Arlington, TX 1 CENTRAL LINE INFUSION

DALLAS DIVISION, LTD. /

AMERITA

8080 TRISTAR DR STE 120

IRVING, TX 75063

(972) 815-0460

2 CORAM HEALTHCARE

CORPORATION OF N TX / CORAM

10105 TECHNOLOGY W BLVD STE

102

(800) 899-7060 (214)

902-3600

Page | v

SPECIALTY INFUSION SERVICES DALLAS, TX 75220



SUPPLIES



(888) 738-7929

4 DIABETIC SOLUTIONS

INCORPORATED / DIABETIC

SOLUTIONS INC

10301 W SAMPLE RD CORAL

SPRINGS, FL 33065

(866) 269-3335 (954)

346-7759


INFUSYSTEM



(800) 962-9656 (248)

291-1210

6 LANDMARK HEALTHCARE INC /

LANDMARK HEALTHCARE INC

8200 TRISTAR DRIVE STE 120

IRVING, TX 75063

(877) 693-0007 (972)

409-0080

7 LINCARE INC. / LINCARE IN 310 WATER ST WAXAHACHIE, TX

75165

(866) 863-5948 (972)

937-4189

8 LINCARE INC. / LINCARE INC 1501 MIDWESTERN PKWY STE 117

WICHITA FALLS, TX 76302

(800) 333-9618 (940)

723-9831

9 LINCARE INC. / LINCARE INC 1631 W MORTON ST DENISON, TX

75020

(866) 440-9853 (903)

463-4880

1

0

LINCARE INC. / LINCARE INC 210 SANTA FE DR WEATHERFORD,

TX 76086

(817) 599-5370

1

1

LINCARE INC. / LINCARE INC 2554 TARPLEY RD STE 104

CARROLLTON, TX 75006

(800) 651-2433 (972)

478-2882

1

2

LINCARE INC. / LINCARE INC 3741 LAMAR AVE PARIS, TX 75462 (888) 701-9663 (903)

739-9663

1

3

LINCARE INC. / LINCARE INC 3884 S SHILOH RD STE 120

GARLAND, TX 75041

(800) 262-2589 (972)

840-4949

1

4

LINCARE INC. / LINCARE INC 508 MEADOWLAKE CTR WACO, TX

76712

(877) 459-4409 (254)

399-9920

1

5

LINCARE INC. / LINCARE INC 5813 WESTCREEK DR FORT

WORTH, TX 76133

(800) 640-0322 (817)

292-6241

1

6

LINCARE INC. / LINCARE INC 717 SOUTH I 35 E STE 132

DENTON, TX 76205

(877) 320-4442 (940)

320-4442

1

7

LINCARE INC. / LINCARE INC 809 N MAIN ST CORSICANA, TX

75110

(877) 872-6027 (903)

872-6020

1

8

LINCARE INC. / LINCARE INC 914 E GOODE ST QUITMAN, TX

75783

(866) 763-0874 (903)

763-0874

1

9

LINCARE INC. / LINCARE INC 927 N PALESTINE ST STE 101

ATHENS, TX 75751

(800) 288-6670 (903)

675-1058

2

0


INC


TEMECULA, CA 92591

(800) 323-6832 (800)

323-6832

2

1



SERVICES

6611 N BELT LINE RD STE 100

IRVING, TX 75063

(800) 879-6137 (972)

536-7355

Page | vi

2

2



MEDIC


STE 110

RIDGELAND, MS 39157

(601) 605-1699

Kansas City, MO-KS 1 AMERITA, INC. / SAFFA

INFUSION PHARMACY

6666 S SHERIDAN RD STE 100

TULSA, OK 74133

(918) 493-2727



SPECIALTY INFUSION SERVICES

2900 FALLING LEAF LANE STE 101

COLUMBIA, MO 65201

(573) 256-4713



SPECIALTY INFUSION SERVICES,

8013 FLINT STREET LENEXA, KS

66214

(800) 726-3481 (913)

850-6700



SUPPLIES



(888) 738-7929


INFUSYSTEM



(800) 962-9656 (248)

291-1210

6 LINCARE INC. / HOME OXYGEN

2-U

1025 N 3RD ST STE 125

LAWRENCE, KS 66044

(800) 361-9115 (785)

832-1317

7 LINCARE INC. / LINCARE 1400 S LIMIT AVE STE 22

SEDALIA, MO 65301

(877) 694-6522 (660)

829-1979

8 LINCARE INC. / LINCARE 439 S BELT HWY

SAINT JOSEPH, MO 64506

(816) 233-9777

9 LINCARE INC. / LINCARE INC 105 WASHINGTON ST

CHILLICOTHE, MO 64601

(800) 383-0950 (660)

646-9991

1

0

LINCARE INC. / LINCARE INC 1114F SOUTHVIEW DR STE A

LIBERTY, MO 64068

(816) 781-4962

1

1

LINCARE INC. / LINCARE INC 125 S MAIN ST NEVADA, MO 64772 (866) 939-8333 (417)

667-8333

1

2

LINCARE INC. / LINCARE INC 2800 SW US HIGHWAY 40

BLUE SPRINGS, MO 64015

(800) 794-6735 (816)

224-0202

1

3

LINCARE INC. / LINCARE INC 411 S KANSAS AVE CLINTON, MO

64735

(877) 514-1430 (660)

885-4416

1

4

LINCARE INC. / LINCARE INC 425 SOUTH MAIN ST OTTAWA, KS

66067

(888) 310-0202 (785)

242-8481

1

5

LINCARE INC. / PLAZA MEDICAL

RESOURCES

1515 SWIFT AVE

NORTH KANSAS CITY, MO 64116

(800) 814-5933 (816)

474-4744

1

6


INC


TEMECULA, CA 92591

(800) 323-6832 (800)

323-6832

1

7



SERVICES

8940 NIEMAN RD OVERLAND PARK,

KS 66214

(800) 879-6137 (913)

599-3745

Miami-Fort Lauderdale-Pompano Beach, FL

Page | vii

1 ADVANTAGE HEALTHCARE INC.

/ ADVANTAGE HEALTHCARE

INC

2832 STIRLING RD L HOLLYWOOD,

FL 33020

(877) 925-2880 (954)

925-2880

2 CISCURA, INC / CISCURA, INC 360 WINKLER DR STE F

ALPHARETTA, GA 30004

(888) 886-8217 (770)

886-8217

3 CORAM HEALTHCARE

CORPORATION OF SOUTHERN

FLORIDA / CORAM SPECIALTY

SERVICES AN APRIA H

11948 MIRAMAR PKWY

# 50

MIRAMAR, FL 33025

(877) 855-6806 (954)

431-3335



SOLUTIONS INC


SPRINGS, FL 33065

(866) 269-3335 (954)

346-7759


INFUSYSTEM



(800) 962-9656 (248)

291-1210

6 LINCARE INC. / ADULT AND


11421NW122ND ST MEDLEY, FL

33178

(800) 772-7147 (305)

888-8714

7 LINCARE INC. / LINCARE INC 107 SW 7TH STREET OKEECHOBEE,

FL 34974

(888) 901-7337 (863)

763-7337

8 LINCARE INC. / LINCARE INC 1300 N FLORIDA MANGO RD STE 30

WEST PALM BEACH, FL 33409

(800) 888-0401 (561)

697-9554

9 LINCARE INC. / LINCARE INC 2885 S CONGRESS AVE SUITE G H

DELRAY BEACH, FL 33445

(800) 940-8989 (561)

266-1011

1

0

LINCARE INC. / LINCARE INC 2952 NW 60TH ST

FORT LAUDERDALE, FL 33309

(800) 200-9568 (954)

977-2954

1

1

LINCARE INC. / LINCARE INC 4443 US HIGHWAY 27 S SEBRING, FL

33870

(800) 282-1255 (863)

471-0027

1

2

LINCARE INC. / LINCARE INC 7965 SW JACK JAMES DR STUART,

FL 34997

(877) 330-8683 (772)

286-0085

1

3

LINCARE INC. / LINCARE INC. 8220 NW 14 STREET DORAL, FL

33126

(305) 392-3990

1

4

LINCARE INC. / PDI PHARMACY

SERVICES

6405 CONGRESS AVE STE 140

BOCA RATON, FL 33487

(561) 997-0330

1

5

MED-CARE INFUSION SERVICES

INC / MEDCARE INFUSION

SERVICES, INC.

3085 W 80TH STREET HIALEAH, FL

33018

(800) 819-0751 (800)

819-0751

1

6

MEDICAL EQUIPMENT

SPECIALISTS, LLC / MEDICAL

EQUIPMENT SPECIALIST LLC

2253 VISTA PKWY STE 6


(561) 697-3999

1

7


INC


TEMECULA, CA 92591

(800) 323-6832 (800)

323-6832

1

8



SERVICES

11650 MIRAMAR PKWY SUITE 100

MIRAMAR, FL 33025

(800) 879-6137 (954)

499-2056

Page | viii

1

9

RESPITEC MEDICAL CARE &

EQUIPMENT INC / RESPITEC

MEDICAL CARE & EQUIPMENT I

1633 W GULF TO LAKE HWY

LECANTO, FL 34461

(800) 945-6685 (800)

945-6685

2

0



MEDICAL-CARE & EQUIPMENT I

401 COMMERCE WAY UNIT 101

LONGWOOD, FL 32750

(800) 945-6685 (407)

834-2266

2

1

ROSEL HOME EQUIPMENT CARE

INC / ROSEL PHARMACY

6900 NW 72ND AVENUE MIAMI, FL

33166

(305) 883-5033

2

2

SOUTH FLORIDA MEDICAL CORP

/ SOUTH FLORIDA MEDICAL

CORP

6462E ROGERS CIR BOCA RATON,

FL 33487

(800) 711-6566 (561)

443-3522

2

3



MEDIC


STE 110

RIDGELAND, MS 39157

(601) 605-1699

Orlando-Kissimmee-Sanford, FL 1 ADVANTAGE HEALTHCARE INC.

/ ADVANTAGE HEALTHCARE

INC

2832 STIRLING RD L HOLLYWOOD,

FL 33020

(877) 925-2880 (954)

925-2880

2 CISCURA, INC / CISCURA, INC 360 WINKLER DR STE F

ALPHARETTA, GA 30004

(888) 886-8217 (770)

886-8217




9143 PHILIPS HWY STE 300

JACKSONVILLE, FL 32256

(800) 365-6275 (904)

363-3089

4 CORAM HEALTHCARE

CORPORATION OF FLORIDA /

CORAM HEALTHCARE

CORPORATION

8508 BENJAMIN RD SUITE C

TAMPA, FL 33634

(800) 683-6987 (813)

639-4500



SOLUTIONS INC


SPRINGS, FL 33065

(866) 269-3335 (954)

346-7759

6 EDWARDS HEALTH CARE

SERVICES, INC. / DIRECT

HEALTHCARE SUPPLY

5640 HUDSON INDUSTRIAL PKWY

HUDSON, OH 44236

(888) 344-3434 (888)

344-3434


INFUSYSTEM



(800) 962-9656 (248)

291-1210

8 LINCARE INC. / ADULT &


7066 STAPOINT CT WINTER PARK,

FL 32792

(407) 551-2900

9 LINCARE INC. / LINCARE 2468 HWY 441 27

STE 513

FRUITLAND PARK, FL 34731

(877) 751-0566 (352)

315-0566

1

0

LINCARE INC. / LINCARE INC 1025 BAY RD

MOUNT DORA, FL 32757

(888) 735-4464 (352)

735-4464

1

1

LINCARE INC. / LINCARE INC 107 SW 7TH STREET OKEECHOBEE,

FL 34974

(888) 901-7337 (863)

763-7337

Page | ix

1

2

LINCARE INC. / LINCARE INC 1607 N NOVA RD STE A

HOLLY HILL, FL 32117

(800) 673-0595 (386)

255-2898

1

3

LINCARE INC. / LINCARE INC 301 S RICHEY ROAD SUITE 101

LEESBURG, FL 34748

(888) 323-5541 (352)

323-5540

1

4

LINCARE INC. / LINCARE INC 3042 MICHIGAN AVE KISSIMMEE,

FL 34744

(800) 631-9843 (407)

846-4144

1

5

LINCARE INC. / LINCARE INC 379 W MICHIGAN ST STE 204

ORLANDO, FL 32806

(407) 425-7114

1

6

LINCARE INC. / LINCARE INC 414 LIVE OAKS BLVD

CASSELBERRY, FL 32707

(800) 895-6644 (407)

682-6644

1

7

LINCARE INC. / LINCARE INC 4443 US HIGHWAY 27 S SEBRING, FL

33870

(800) 282-1255 (863)

471-0027

1

8

LINCARE INC. / LINCARE INC 7965 SW JACK JAMES DR STUART,

FL 34997

(877) 330-8683 (772)

286-0085

1

9

LINCARE INC. / LINCARE INC 90 1ST STREET S STE A

WINTER HAVEN, FL 33880

(888) 252-3113 (863)

291-3113

2

0

MEDICAL EQUIPMENT

SPECIALISTS, LLC / MEDICAL

EQUIPMENT SPECIALIST LLC

2253 VISTA PKWY STE 6


(561) 697-3999

2

1


INC


TEMECULA, CA 92591

(800) 323-6832 (800)

323-6832

2

2



SERVICES

2880 SCHERER DR N STE 840-850

SAINT PETERSBURG, FL 33716

(800) 879-6137 (727)

592-0045

2

3



MEDICAL CARE & EQUIPMENT I

1633 W GULF TO LAKE HWY

LECANTO, FL 34461

(800) 945-6685 (800)

945-6685

2

4



MEDICAL-CARE & EQUIPMENT I

401 COMMERCE WAY UNIT 101

LONGWOOD, FL 32750

(800) 945-6685 (407)

834-2266

2

5

SOUTH FLORIDA MEDICAL CORP

/ SOUTH FLORIDA MEDICAL

CORP

6462E ROGERS CIR BOCA RATON,

FL 33487

(800) 711-6566 (561)

443-3522

2

6



MEDIC


STE 110

RIDGELAND, MS 39157

(601) 605-1699

Pittsburgh, PA 1 CORAM ALTERNATE SITE


ALTERNATE SITE SERVICES, INC

220 EXECUTIVE DR 500

CRANBERRY TOWNSHIP, PA 16066

(800) 876-3701 (724)

772-3705



SOLUTIONS INC


SPRINGS, FL 33065

(866) 269-3335 (954)

346-7759

Page | x


HOME INC. / ADULT AND

PEDIATRIC SPECIALISTS

655 RODI RD

STE 203 ONE RODI PLAZA

PITTSBURGH, PA 15235

(888) 321-0681 (412)

371-0008



SOLUTIONS

114 S BROAD ST GROVE CITY, PA

16127

(724) 458-7607



SOLUTIONS

1503 WILMINGTON RD NEW

CASTLE, PA 16105

(724) 652-3300



SOLUTIONS

237 KRUGER ST WHEELING, WV

26003

(877) 743-9605 (304)

243-9605



SOLUTIONS

3520 PENNSYLVANIA AVE

WEIRTON, WV 26062

(800) 637-2342 (304)

723-1639



SOLUTIONS

911 GREENBAG RD

MORGANTOWN, WV 26508

(800) 323-2026 (304)

292-9801



SOLUTIONS

946 MANIFOLD RD STE 101

WASHINGTON, PA 15301

(877) 207-2092 (724)

222-4292

1

0

HEALTH CARE SOLUTIONS AT


SOLUTIONS AT HOME INC

2301 DUSS AVE STE 15 BLDG 15

AMBRIDGE, PA 15003

(724) 266-7890

1

1


HOME INC. / HEALTHCARE

SOLUTIONS

5103 CENTER DR STE B

LATROBE, PA 15650

(724) 537-0202

1

2


HOME INC. / HEALTHCARE

SOLUTIONS AT HOME

205-D SOUTH DUFFY ROAD

BUTLER, PA 16001

(888) 431-0228 (724)

431-0226

1

3

HOME INFUSION SOLUTIONS,

LLC / HOME SOLUTIONS

150 LAKE DR STE 105

WEXFORD, PA 15090

(724) 759-2500

1

4

INFUSYSTEM, INC. /

INFUSYSTEM



(800) 962-9656 (248)

291-1210

1

5

LINCARE INC. / LINCARE INC 1295 GRAND BLVD STE 105

MONESSEN, PA 15062

(724) 684-4494

1

6

LINCARE INC. / LINCARE INC 136 HOLLYWOOD BLVD

STEUBENVILLE, OH 43952

(740) 264-1630

1

7

LINCARE INC. / LINCARE INC 1710 WILMINGTON RD NEW

CASTLE, PA 16105

(724) 658-4955

1

8

LINCARE INC. / LINCARE INC 19W FAYETTE ST UNIONTOWN, PA

15401

(888) 505-4911 (724)

438-7992

1

9

LINCARE INC. / LINCARE INC 215 WARWOOD AVE WHEELING,

WV 26003

(800) 561-6468 (304)

277-1006

2

0

LINCARE INC. / LINCARE INC 401 BOYERS AVE STAR CITY, WV

26505

(877) 311-8990 (304)

296-7209

Page | xi

2

1

LINCARE INC. / LINCARE INC. 2809 BANKSVILLE RD

PITTSBURGH, PA 15216

(800) 441-3602 (412)

388-1400

2

2

LINCARE INC. / LINCARE INC. 374 W MAIN ST STE 500

SOMERSET, PA 15501

(814) 445-6290

2

3


INC


TEMECULA, CA 92591

(800) 323-6832 (800)

323-6832

2

4



SERVICES

540 SECO RD STE A

MONROEVILLE, PA 15146

(800) 879-6137 (412)

373-2784

2

5


SEELEY MEDICAL

1160 GEORGE WASHINGTON BLVD

STE H

AKRON, OH 44312

(800) 473-3539 (330)

733-0996

2

6


SEELEY MEDICAL

900 E 222ND ST EUCLID, OH 44123 (800) 473-3539 (216)

289-7424

2

7



MEDIC


STE 110

RIDGELAND, MS 39157

(601) 605-1699

2

8

VANTAGE HME, LIMITED /

VANTAGE HOME INFUSION

THERAPY SERVI

11031 PERRY HWY STE 105

MEADVILLE, PA 16335

(814) 333-9449

Riverside-San Bernardino-Ontario, CA 1 BEACHWOOD MEDICAL SUPPLY,

INC / BEACHWOOD MEDICAL

SUPPLY

13851 GARVEY AVE SUITE B3

BALDWIN PARK, CA 91706

(877) 695-3632 (626)

338-5300

2 CORAM HEALTHCARE


CALIFORNIA / CORAM

HEALTHCARE CORP OF

SOUTHERN C

3002 DOW AVE STE 104

TUSTIN, CA 92780

(800) 900-0305 (714)

665-1121

3 CORAM HEALTHCARE


CALIFORNIA / CORAM

HEALTHCARE CORPORATION OF

S C

4355 E LOWELL ST STE C

ONTARIO, CA 91761

(800) 806-7696 (909)

605-0010

4 CRESCENT HEALTHCARE, INC. /

CRESCENT HEALTHCARE INC

2010 IOWA AVE STE 110

RIVERSIDE, CA 92507

(800) 879-6137 (951)

774-1844

5 DESERT MEDICAL EQUIPMENT,

INC / DESERT MEDICAL

EQUIPMENT INC

13630 PAWNEE RD STE 4 BLDG 1

APPLE VALLEY, CA 92308

(760) 247-2903



SUPPLIES



(888) 738-7929

7 DIAMOND RESPIRATORY CARE

INC / DIAMOND RESPIRATORY

CARE INC

1403 PALMYRITA AVE RIVERSIDE,

CA 92507

(800) 977-3002 (951)

686-0418

Page | xii


INFUSYSTEM



(800) 962-9656 (248)

291-1210

9 K AND S OWL INC / OWL

HOMECARE PHARMACY

13851 GARVEY AVE SUITE A

BALDWIN PARK, CA 91706

(626) 851-9199

1

0

LINCARE INC. / LINCARE INC 10571 CALLE LEE STE 155

LOS ALAMITOS, CA 90720

(800) 600-6420 (714)

220-6420

1

1

LINCARE INC. / LINCARE INC 13455 MALAKI RD STE 6

APPLE VALLEY, CA 92308

(760) 961-2066

1

2

LINCARE INC. / LINCARE INC 2015 W PARK AVE STE 16

REDLANDS, CA 92373

(800) 759-1569 (909)

793-0802

1

3

LINCARE INC. / LINCARE INC 2326N BATAVIA ST 115

ORANGE, CA 92865

(714) 637-7570

1

4

LINCARE INC. / LINCARE INC 36425 BANKSIDE DR STE A

CATHEDRAL CITY, CA 92234

(800) 491-3625 (760)

328-1200

1

5

LINCARE INC. / LINCARE INC 41765 ELM ST STE 201

MURRIETA, CA 92562

(888) 994-2059 (951)

894-2059

1

6

LINCARE INC. / LINCARE INC 42207 6TH ST W STE 101

LANCASTER, CA 93534

(888) 559-0015 (661)

949-0015

1

7


INC


TEMECULA, CA 92591

(800) 323-6832 (800)

323-6832

1

8

PHARMACO INC. / PREMIER

INFUSION CARE

2341W 205TH ST 113

TORRANCE, CA 90501

(866) 365-2525 (310)

328-3897

1

9

SAINT PAUL ENTERPRISES INC /

OWL REXALL DRUG

401N VINCENT AVE COVINA, CA

91722

(800) 727-8396 (626)

962-1061

Page | xiii

Appendix B

Insulin Pump Survey

Survey Script

Action:

Locate in the survey spreadsheet the name of the company with whom you are speaking.

Answers to the survey will be documented in this spreadsheet. It is important that the

information be entered in the correct places. All documentation of interviews must be done using

the spreadsheet.

Prompt 1:

Hello, my name is ___________ and I am a diabetes educator. I work with a large number of

patients who utilize insulin pumps and insulin pump supplies to manage their diabetes. Because

Medicare is piloting competitive bidding in 9 areas around the country, I am trying to educate

myself on the products that are going to be available so that I can in turn help these patients find

what they need. I see on the CMS website that you carry a range of different brands and models

of infusion pumps. This may take a few minutes, but can I run through the list with you just to

confirm that you do carry insulin pumps and their corresponding supplies? This information is

going to help me advise patients on where they can find their specific brand of insulin pump and

supplies.

If negative response:

Is there a better time that I can call to speak with someone? It’s very important to our research

that we speak with a representative of your company.

Prompt 2:

Thank you, may I have your name please? (Repeat the name), this won’t take more than about 5

minutes of your time, if even that long. Your responses are very important and I promise to not

waste your time.

Action:

Document the person’s name with whom you are speaking.

Prompt 3:

Your company is listed as an eligible supplier of infusion pumps and supplies under Medicare’s

competitive bidding program. Is this correct?

If positive response:

Document in the spreadsheet that the company is still participating in the Round 1 re-compete

program.


Do you know why Medicare has your company listed as an eligible supplier?

Prompt 3a:

As there are multiple types of infusion pumps in this Pilot program, does your company currently

Page | xiv

carry Insulin Infusion pumps?


Document in the spreadsheet that the company carries Insulin pumps and move to Prompt 3b.


Does your company have any experience providing insulin pumps to patients (within the last two

years)?

What does your company instruct patients to do that are looking for insulin pumps?

Prompt 3b:

In addition to insulin pumps, beneficiaries require supplies that work with a particular brand of

pump. Do you currently carry insulin pump supplies? i.e. infusion sets and reservoirs?


Document in the spreadsheet the company carries Insulin pump supplies, and move to prompt 4.


Has your company ever carried insulin pump supplies, for example in the past 2 years?


Does your company plan to carry insulin pumps and supplies in the near future? What does your

company instruct patients to do that are looking for insulin pump supplies?

Prompt 4: (if the company answered positive in carrying insulin pumps and/or insulin pump

supplies)

Great, now I’d like to confirm that your company carries the brands and models that are listed on

the Medicare.gov website. I’ll go through the brands one at a time. Please tell me if you carry

that particular brand and model. Are you ready?

Action:

Surveyors should locate the company name in the attached spreadsheet. Reading down the left

most two columns of the spreadsheet, read off the brand and model name of each pump and

supply, allowing adequate time for the respondent to indicate an answer. Repeat prompts for

each brand and model listed on the spreadsheet. Indicate the answers where shown on the

spreadsheet.

Prompt 5:

Do you carry this product (product name) yes or no?


Document in spreadsheet

Continue to prompt 6


How would you respond to a patient who has (product name) brand of pump, and therefore needs

that brand of pump supplies?


Did you every carry this product yes or no?


Why don’t you carry it anymore?

Document answer in spreadsheet.

Page | xv


Document in spreadsheet.

Prompt 6:

Is this product currently available for purchase, yes or no?





How would you support a patient who has (product name) brand of pump, and therefore needs

that brand of pump supplies?

Why is this product not available for purchase?

Prompt 7:

Is this product available to be shipped today?





When will this product be available to be shipped?

Prompt 8:

Are there any other insulin pump or supply brands and models that you carry that we haven’t

already talked about?





Prompt 9:

Thank you very much for your time. I greatly appreciate that you took the time to talk with me.

Your answers will be most helpful

Appendix C: Insulin Pump Availability

Pump Only Competitive Bidding Area

Charlotte

CONTRACT SURVEYED INSULIN PUMP

ANIMAS MEDTRONIC ROCHE TANDEM OTHERS

Advantage Home Care

BioPlus Specialty Pharmacy

Carolinas Medical Center

Ciscura

Coram Healthcare

Crescent Healthcare

Diabetes Management & Supplies Dusara Corp Universal Med Supply

Edwards Health Care

Home Infusion Solutions

Homechoice

Infusytem

Liberty Medical Specialties Lincare

Medical Comfort Systems

Medpro RX

Nufactor

Option Care Enterprise/Walgreens

Outpatient Infusion Systems

19 10 5 3 4 3 3 2


Cincinnati



Amerimend

Coram Healthcare

Cornerstone Medical

Crescent Healthcare

Diabetes Management & Supplies

Dusara Corp Universal Med Supply

Infusytem

Lincare

Nufactor

Option Care Enterprise


University Option Care

12 7 2 2 1 1 1 0


Cleveland



Advanced Infusion Services


Caring Solution

Convacare Services

Coram Healthcare



Health Care Solutions

Infusytem

Kaup Pharmacy

Lincare

Medpro RX

Nufactor



Seeley Medical Oxygen


University Hospitals Homecare

18 8 1 1 1 1 1 1


Dallas



Biofusion


Central Line Infusion

Ciscura

Convacare Services

Coram Healthcare


Diabetic Solutions


Infusytem

Landmark Healthcare

Lincare

Nufactor



Southern Pharmaceutical Corp

16 9 7 4 3 2 4 1


Kansas City



Amerita

Biofusion


Coram Healthcare

Crescent Healthcare



Infusytem

Lincare

Nufactor

Option Care Enterprise /Walgreens


12 5 1 0 0 1 0 0


Miami



Advantage Healthcare

Biofusion


Ciscura

Coram Healthcare

Crescent Healthcare

Diabetic Solutions

Health First Infusion

Infusytem

Lincare

Med-Care Infusion Services

Medical Equipment Specialists

Medicor HealthChoice

North Broward Infusion Group

Nufactor

Option Care Enterprise / Walgreens


Respitec Medical Care

Rosel Home Equipment

South Florida Medical Corp

20 13 8 3 2 2 1 1


Orlando



Advantage Healthcare

Biofusion


Ciscura

Coram Healthcare

Crescent Healthcare

Diabetic Solutions

Edwards Health Care

Florida Hospital Home Infusion

Infusytem

Lincare

Medical Equipment Specialists

Medicor HealthChoice

Nufactor

Option Care Enterprise /Walgreens Respitec Medical Care

South Florida Medical Corp

17 7 3 2 1 1 1 2


Pittsburgh



Biofusion


Ciscura

Coram Healthcare

Crescent Healthcare


Diabetic Solutions


Edwards Health Care



Infusytem

Lincare

Medpro RX

Nufactor



Personal Support Medical


Vantage Home

20 7 1 1 1 0 0 0


Riverside



Beachwood Medical

Biofusion


Coram Healthcare

Crescent Healthcare

Desert Medical Equipment


Diamond Respiratory Care


Infusytem

K&S Owl

Lincare

Nufactor


Pharmaco Saint Paul Enterprises

16 8 1 0 0 0 0 1

Appendix D: Supply Kit Availability

Supplies Only Competitive Bidding Area

Charlotte

CONTRACT SURVEYED SETS ANIMAS MEDTRONIC ROCHE TANDEM OTHERS

Advanced Home Care


Carolinas Medical Center

Ciscura

Coram Healthcare

Crescent Healthcare



Edwards Health Care


Homechoice

Infusytem

Liberty Medical Specialties

Lincare

Medical Comfort Systems

Medpro RX

Nufactor



19 10 6 3 5 3 2 2


Cincinnati


Amerimend

Coram Healthcare

Cornerstone Medical

Crescent Healthcare



Infusytem

Lincare

Nufactor




12 7 2 2 1 1 1 0


Cleveland


Advanced Infusion Services


Caring Solution

Convacare Services

Coram Healthcare




Infusytem

Kaup Pharmacy

Lincare

Medpro RX

Nufactor





University Hospitals Homecare

18 8 1 1 1 1 1 1


Dallas


Biofusion BioPlus Specialty Pharmacy Central Line Infusion Ciscura Convacare Services Coram Healthcare Diabetes Management & Supplies Diabetic Solutions Dusara Corp Universal Med Supply Infusytem Landmark Healthcare Lincare Nufactor Option Care Enterprise/Walgreens Outpatient Infusion Systems Southern Pharmaceutical Corp 16 9 7 4 5 3 5 1


Kansas City


Amerita Biofusion BioPlus Specialty Pharmacy Coram Healthcare Crescent Healthcare Diabetes Management & Supplies Dusara Corp Universal Med Supply Infusytem Lincare Nufactor Option Care Enterprise /Walgreens Outpatient Infusion Systems 12 5 1 0 0 1 0 0


Miami


Advantage Healthcare Biofusion BioPlus Specialty Pharmacy Ciscura Coram Healthcare Crescent Healthcare Diabetic Solutions Health First Infusion Infusytem Lincare Med-Care Infusion Services Medical Equipment Specialists

Medicor HealthChoice North Broward Infusion Group Nufactor Option Care Enterprise / Walgreens Outpatient Infusion Systems Respitec Medical Care Rosel Home Equipment South Florida Medical Corp

20 13 8 3 2 2 1 1


Orlando


Advantage Healthcare Biofusion BioPlus Specialty Pharmacy Ciscura Coram Healthcare Crescent Healthcare Diabetic Solutions Edwards Health Care Florida Hospital Home Infusion Infusytem Lincare Medical Equipment Specialists

Medicor HealthChoice Nufactor


Respitec Medical Care South Florida Medical Corp

17 7 3 2 1 1 1 2


Pittsburgh


Biofusion BioPlus Specialty Pharmacy Ciscura Coram Healthcare Crescent Healthcare Diabetes Management & Supplies Diabetic Solutions Dusara Corp Universal Med Supply Edwards Health Care Health Care Solutions Home Infusion Solutions Infusytem Lincare Medpro RX

Nufactor Option Care Enterprise /Walgreens

Outpatient Infusion Systems Personal Support Medical Seeley Medical Oxygen Vantage Home

20 7 2 2 2 1 1 1


Riverside


Beachwood Medical Biofusion BioPlus Specialty Pharmacy Coram Healthcare Crescent Healthcare Desert Medical Equipment Diabetes Management & Supplies Diamond Respiratory Care Dusara Corp Universal Med Supply Infusytem K&S Owl Lincare Nufactor Outpatient Infusion Systems Pharmaco Saint Paul Enterprises 16 8 1 1 0 1 1 0

Appendix E: Reservoir Availability

Reservoir Only Competitive Bidding Area

Charlotte

CONTRACT SURVEYED RESERVOIR ANIMAS MEDTRONIC ROCHE TANDEM OTHERS

Advanced Home Care BioPlus Specialty Pharmacy Carolinas Medical Center Ciscura Coram Healthcare Crescent Healthcare Diabetes Management & Supplies

Dusara Corp Universal Med Supply Edwards Health Care Home Infusion Solutions Homechoice Infusytem Liberty Medical Specialties

Lincare Medical Comfort Systems Medpro RX Nufactor Option Care Enterprise/Walgreens Outpatient Infusion Systems 19 10 6 3 5 3 2 2


Cincinnati


Amerimend Coram Healthcare Cornerstone Medical Crescent Healthcare Diabetes Management & Supplies Dusara Corp Universal Med Supply Infusytem Lincare Nufactor Option Care Enterprise Outpatient Infusion Systems University Option Care 12 7 2 2 1 1 1 0


Cleveland


Advanced Infusion Services BioPlus Specialty Pharmacy Caring Solution Convacare Services Coram Healthcare

Diabetes Management & Supplies Dusara Corp Universal Med Supply Health Care Solutions Infusytem Kaup Pharmacy Lincare Medpro RX Nufactor Option Care Enterprise Outpatient Infusion Systems Seeley Medical Oxygen University Option Care University Hospitals Homecare 18 8 1 1 1 1 1 1


Dallas


Biofusion BioPlus Specialty Pharmacy Central Line Infusion Ciscura Convacare Services Coram Healthcare Diabetes Management & Supplies Diabetic Solutions Dusara Corp Universal Med Supply Infusytem Landmark Healthcare Lincare Nufactor Option Care Enterprise/Walgreens

Outpatient Infusion Systems Southern Pharmaceutical Corp 16 9 7 4 4 3 5 1


Kansas City


Amerita Biofusion BioPlus Specialty Pharmacy Coram Healthcare Crescent Healthcare Diabetes Management & Supplies Dusara Corp Universal Med Supply Infusytem Lincare Nufactor Option Care Enterprise /Walgreens Outpatient Infusion Systems 12 5 1 0 0 1 0 0


Miami


Advantage Healthcare Biofusion BioPlus Specialty Pharmacy Ciscura Coram Healthcare Crescent Healthcare Diabetic Solutions Health First Infusion Infusytem Lincare Med-Care Infusion Services Medical Equipment Specialists

Medicor HealthChoice North Broward Infusion Group Nufactor Option Care Enterprise / Walgreens Outpatient Infusion Systems Respitec Medical Care Rosel Home Equipment South Florida Medical Corp

20 13 8 3 2 2 1 1


Orlando


Advantage Healthcare Biofusion BioPlus Specialty Pharmacy Ciscura Coram Healthcare Crescent Healthcare Diabetic Solutions Edwards Health Care Florida Hospital Home Infusion Infusytem Lincare Medical Equipment Specialists

Medicor HealthChoice Nufactor Option Care Enterprise /Walgreens

Respitec Medical Care South Florida Medical Corp

17 7 3 2 1 1 1 2


Pittsburgh


Biofusion BioPlus Specialty Pharmacy Ciscura Coram Healthcare Crescent Healthcare Diabetes Management & Supplies Diabetic Solutions Dusara Corp Universal Med Supply Edwards Health Care Health Care Solutions Home Infusion Solutions Infusytem Lincare Medpro RX

Nufactor Option Care Enterprise /Walgreens

Outpatient Infusion Systems Personal Support Medical Seeley Medical Oxygen Vantage Home

20 7 2 2 2 1 1 1


Riverside


Beachwood Medical Biofusion BioPlus Specialty Pharmacy Coram Healthcare Crescent Healthcare Desert Medical Equipment Diabetes Management & Supplies Diamond Respiratory Care Dusara Corp Universal Med Supply Infusytem K&S Owl Lincare Nufactor Outpatient Infusion Systems Pharmaco Saint Paul Enterprises 16 8 1 0 0 1 1 0

competitive bidding program external aade...medicare considers an insulin pump to be durable medical...

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