ADS Takes the Hassle Out of CGM Billing for Retail Pharmacies

Theresa Flaherty, Managing Editor

Updated Fri April 17, 2020

CARLSBAD, Calif. – Advanced Diabetes Supply aims to fill a gap in the workflows of retail pharmacies through a recent partnership with Price Chopper/Market 32.

Per the partnership, the company will offer its line of continuous glucose monitors to the pharmacy’s Medicare Part B patients.

“Retail pharmacies really don’t like to bill Part B because of all the documentation requirements,” says Tim Cady, president of ADS. “They know how onerous it is to get the medical records from the physicians with all the various components to qualify for CGM and it doesn’t fit into their workflow.”

The Schenectady, N.Y.-based Price Chopper/Market 32 supermarket chain has 82 pharmacies throughout the Northeast.

By partnering with ADS, Price Chopper/Market 32 puts its patients in trusted hands for CGMs, and Price Chopper/Market 32 retains satisfied customers, says Cady.

“People with diabetes are very important customers to retail pharmacies for all their prescriptions and other items they buy,” he said. “They don’t want to say ‘no’ to the patient. Now they can say, ‘We can’t bill Part B, but we have a partner in ADS that are experts that can help you.’”

Once a patient with a valid prescription consents to being contacted by ADS, the provider follows up within 24 hours to begin the intake process. The patient receives regular updates on the status of their order, as well as anticipated costs of the CGM and supplies based on their insurance.

Demand by Medicare beneficiaries for CGM devices is on the rise, driven in large part by targeted TV advertising campaigns during programs like “The Price is Right” and “Jeopardy,” says Cady.

“They are going straight after the Medicare customers,” he said.

Newer technology like CGMs and insulin pumps have meant consistent growth for the past several years for ADS, which pivoted toward the products after losing half of its business on July 1, 2013, when the national mail-order diabetes contracts took effect, says Cady.

“We had a really horrible 2013, but we’ve gotten into (these product categories) and so we’ve been able to build back up and we are growing,” he said.