This topic is about a proposal from the Centers for Medicare & Medicaid Services (CMS) that could impact access to specialized ostomy products. The proposal suggests including ostomy, tracheostomy, and urological supplies in a competitive bidding program, which might affect how these products are supplied and priced. Here are some key points and advice related to this proposal:

- All ostomy supplies, such as pouches, barriers, adhesives, and belts, would be grouped into one category. Suppliers would need to provide every item in this category to secure a contract.
- Bidding would focus on a "lead item," which is the product with the highest historical Medicare charges. Suppliers would submit a price for this item, and that price would determine their bid for the entire category.
- CMS would arrange bids from lowest to highest and select contracts until the projected demand is met. The highest bid included is called the "pivotal bid." Suppliers with bids at or below this amount would become contract suppliers, setting the Single Payment Amounts (SPAs).
- The SPA for the lead item would be the 75th percentile of winning bids. SPAs for other items would be calculated using ratios from 2015 local fee-schedule data.
- Contract suppliers must provide all ostomy items at or below their SPA and cannot charge patients extra.
- Suppliers that only manufacture or stock a few items might be excluded because they can't meet the "full-line" requirement. This could disadvantage smaller manufacturers and favor larger ones like Coloplast, ConvaTec, and Hollister.

Additional insights and advice:

1. Medicare Coverage & Belts:
- Original Medicare Parts A/B typically do not reimburse for Nu-Hope belts. Many people pay out-of-pocket and buy these belts directly from online retailers without needing a prescription. Nu-Hope Corporation offers excellent customer support for direct orders.

2. Extending Supply Life:
- If products become harder to obtain, consider extending the wear time of wafers/flanges, especially if you have predictable output. For example, with a Hollister 2-piece system, you might try wearing them for 7 to 12 days to reduce the use of barriers, rings, wipes, and sprays.
- Use a Sharpie to write the change date on the wafer for easy tracking.
- Shower with the appliance on and change only the pouch as needed, keeping the same wafer/flange.

3. Adhesive Removal Technique (Hollister Products):
- Use a medical adhesive remover spray to loosen the tape edge.
- Open a Hollister Adapt 7760 remover-wipe packet, leave the wipe inside, and pour the packet fluid between your skin and the seal to easily release the wafer.
- Use the saturated wipe to remove any remaining adhesive. If the wipe dries, pour the remaining packet fluid on it to re-wet and finish cleaning.

4. General Insurance Insights:
- Understand the difference between Original Medicare (Parts A, B, D + Medigap) and Medicare Advantage (Part C). Medigap cannot be used with Advantage plans.
- Be aware that the increasing use of prior authorization in both Advantage plans and the proposed Traditional Medicare pilot could complicate access to specialty ostomy products.