ARTICLE SUMMARY:
CMS is moving forward with plans to institute competitive bidding for continuous glucose monitors and insulin pumps. The reaction from industry has been largely negative, with pricing pressures a top concern. But there could be substantial upside if the program’s lower out-of-pocket costs drive more Medicare patients to pump therapy.
In the face of strong opposition from industry and political allies, the US Centers for Medicare and Medicaid Services (CMS) finalized a plan in late November to initiate competitive bidding for Class II continuous glucose monitors (CGMs) and insulin pumps supplied to Medicare fee-for-service (FFS) recipients through the durable medical equipment (DME) channel. The program, which also includes urological, ostomy, and tracheostomy supplies and some off-the-shelf brace products, has a targeted start date of no later than January 1, 2028, with the bid window for DME suppliers opening in late summer or early fall 2026 and contracts awarded a year later in 2027.
Medtech advocates including AdvaMed unsuccessfully lobbied CMS to abandon the plan, arguing it could restrict patient access and innovation for diabetes devices. However, the impact of the newly adopted policies will likely be more nuanced and will vary by stakeholder. DME suppliers will bear the brunt of the shift as they take on more risk and face pressure on margins, while diabetes device manufacturers could see both upsides and downsides, with pricing pressure and competitive switching emerging as top concerns.
