A plan to introduce competitive bidding for these medical products will hurt patients

Do you know someone with an ostomy? I bet you do, but you might not know it.

The public often refers to an ostomy as a “colostomy bag.” But that’s an oversimplification.  An ostomy is a surgery that creates a new opening (stoma) on the abdomen for an individual to eliminate waste.

When the fit is right, most people get on with their lives. When it is wrong, the consequences can be immediate and deeply disruptive. It is this precise reason why Medicare’s decision to bring ostomy supplies into competitive bidding is bad policy.

Scheduled to take effect no later than Jan. 1, 2028, The Centers for Medicare and Medicaid Services (CMS) says competitive bidding will lower costs for beneficiaries and reduce fraud, waste and abuse. These are both worthy goals. But saving money on an ostomy product is not necessarily saving money on healthcare—and fighting bad actors at the expense of patients’ access and choice is the wrong strategy.

As a patient, I know where the real cost can show up.

It shows up when my pouch leaks and effluent damages my skin.

It shows up when I cannot leave the house because I am worried about an accident, or when I lose sleep because I fear missing work.

And, in more serious cases, it shows up as a trip to the emergency room.

The fundamental problem with competitive bidding is that it treats products as though they are interchangeable, like a walker or knee brace. Ostomy supplies are not one-size-fits-all. They are prescribed to meet each person’s unique needs — stoma type and size, skin condition, body shape and lifestyle. I went through three different brands of skin barriers and bags before I found a combination that fit my body, and provided me with a sense of security.

Consider eyeglasses. A prescription that works for one person would not work for everyone. Ostomy supplies are no different.

Two products may look similar while behaving completely differently on an individual’s body. One person may need a particular adhesive because of their skin type. Someone else may require a specific pouching configuration for their body or lifestyle.

The federal government points to safeguards, saying that when a physician specifically prescribes a particular brand to avoid an adverse medical outcome, contract suppliers must provide it or help the beneficiary find a supplier that can. This all sounds reassuring on paper. But patients should not have to become medical advocates, insurance experts and supply negotiators every time they reorder the products that allow them to function normally. Nor should they have to wait until a problem becomes a documented “adverse medical outcome” before getting access to what works. Preventing complications is the whole point of good ostomy care.

I am not opposed to controlling Medicare spending. I want to eliminate unnecessary costs just like any taxpayer. But there is a difference between eliminating waste and creating incentives to substitute products that are cheaper but less appropriate for a particular patient. 

If a lower-priced product works perfectly for me, great. But the determination should be based on whether it works for me — not simply whether it won a bidding process.

An ostomy is already a profound adjustment. Many of us have had this life-saving surgery because of birth defects, cancer, inflammatory bowel disease, trauma or other serious medical conditions. We have learned to care for a part of our body in a way we never expected. We have adapted our routines and our sense of self. The least our healthcare system can do is recognize that the products we depend on are not interchangeable widgets.

The question should never be, “How cheaply can Medicare buy this pouch?” but rather, “What does this patient need to stay healthy, independent and out of the hospital?

I am reminded daily that when it comes to something as essential as managing my own body safely and with dignity, the lowest bid should never be more important than the right fit.