FDA petition to grant OTC status to CPAP machines

gotaug2 wrote: ↑

Fri Mar 14, 2025 2:39 am

Regarding the concer that insurance would stop covering CPAP:
Plenty of things like wheelchairs and other durable medical equipment don't require prescriptions and are still covered by insurance.

I can't tell you about private insurance or other DME, but Medicare will not pay for a wheelchair without an order (prescription) from a doctor.

super7pilot wrote: ↑

Mon Mar 17, 2025 4:55 pm

Well, The vast majority of routine uncomplicated apneas found in a patient in an in lab study. (Like me) Were sent home with a pap machine that was set at the factory 4cm-20cm setting. And just let the machine adjust on it's own. That is a rubbish way to treat a patient. So, what's the difference of going home from the Dr. or from costco with a machine set to 4cm-20cm. NONE at all.

It was this and the other apnea site that sent me towards better sleep. My VA sleep Dr saw the settings and sleep reports on my machine that I got from these two pages and said: Good job!

"Well, The vast majority of routine uncomplicated apneas found in a patient in an in lab study. (Like me) Were sent home with a pap machine that was set at the factory 4cm-20cm setting."

How exactly do you know what settings the vast majority of diagnosed uncomplicated apnea patients are using? I most certainly was not sent home with those standard settings after my lab diagnosis.

I was, And in my time on the two apnea forums. I have seen that a majority have been sent home with 4-20 settings. Of course there are exceptions from exceptional Dr's.

A great many of the treatment threads start off with some version of "I'm starving for air" "My AHI is low but can't get restful sleep" And the common thread in those? VERY low min pressure as set by the pap manufacturer.

super7pilot wrote: ↑

Tue Mar 18, 2025 11:12 am

I was, And in my time on the two apnea forums. I have seen that a majority have been sent home with 4-20 settings. Of course there are exceptions from exceptional Dr's.

A great many of the treatment threads start off with some version of "I'm starving for air" "My AHI is low but can't get restful sleep" And the common thread in those? VERY low min pressure as set by the pap manufacturer.

You said it right there. You're reading and reporting on what you've read on these forums. I would hardly call that the vast majority of CPAP patients as the vast majority of patients do not even participate in these forums.

I know, I know, semantics...

Conrad wrote: ↑

Wed Mar 19, 2025 6:49 am

super7pilot wrote: ↑

Tue Mar 18, 2025 11:12 am

I was, And in my time on the two apnea forums. I have seen that a majority have been sent home with 4-20 settings. Of course there are exceptions from exceptional Dr's.

A great many of the treatment threads start off with some version of "I'm starving for air" "My AHI is low but can't get restful sleep" And the common thread in those? VERY low min pressure as set by the pap manufacturer.

You said it right there. You're reading and reporting on what you've read on these forums. I would hardly call that the vast majority of CPAP patients as the vast majority of patients do not even participate in these forums.

I know, I know, semantics...

Yes, and it's unlikely that the people posted here constitute a statistically significant sample size.

ChicagoGranny wrote: ↑

Wed Mar 19, 2025 7:25 am

Conrad wrote: ↑

Wed Mar 19, 2025 6:49 am

super7pilot wrote: ↑

Tue Mar 18, 2025 11:12 am

I was, And in my time on the two apnea forums. I have seen that a majority have been sent home with 4-20 settings. Of course there are exceptions from exceptional Dr's.

A great many of the treatment threads start off with some version of "I'm starving for air" "My AHI is low but can't get restful sleep" And the common thread in those? VERY low min pressure as set by the pap manufacturer.

You said it right there. You're reading and reporting on what you've read on these forums. I would hardly call that the vast majority of CPAP patients as the vast majority of patients do not even participate in these forums.

I know, I know, semantics...

Yes, and it's unlikely that the people posted here constitute a statistically significant sample size.

Even if the size was large enough, the folks who come here are not the average CPAP users for the most part. Most everyone here is trying to be proactive in their own care, that's not what I believe that the vast majority do.

People come here because CPAP isn't working for them, or they have unanswered questions, otherwise they would be watching Netflix or golfing or whatever.

If the medical-industrial complex was doing its job, this would be a quiet place.

If only a small percentage of the people who have mismanaged sleep apnea treatment show up here or in other forums, think of all the people who never find adequate help.

gotaug2 wrote: ↑

Sun Mar 30, 2025 8:01 pm

People come here because CPAP isn't working for them, or they have unanswered questions, otherwise they would be watching Netflix or golfing or whatever.

If the medical-industrial complex was doing its job, this would be a quiet place.

If only a small percentage of the people who have mismanaged sleep apnea treatment show up here or in other forums, think of all the people who never find adequate help.

And what should be done about these people who can't even be proactive in their own health care?

gotaug2 wrote: ↑

Sun Mar 30, 2025 8:01 pm

If the medical-industrial complex was doing its job

Ridiculous viewpoint. For many people, the use of CPAP takes a lot of experimenting and tweaking. Societies cannot pay for medical professionals to spend all these hours.

It's rightly a DIY process. Ever visited the DIY section of a library or YouTube?

Conrad wrote: ↑

Tue Mar 18, 2025 7:42 am

super7pilot wrote: ↑

Mon Mar 17, 2025 4:55 pm

Well, The vast majority of routine uncomplicated apneas found in a patient in an in lab study. (Like me) Were sent home with a pap machine that was set at the factory 4cm-20cm setting. And just let the machine adjust on it's own. That is a rubbish way to treat a patient. So, what's the difference of going home from the Dr. or from costco with a machine set to 4cm-20cm. NONE at all.

It was this and the other apnea site that sent me towards better sleep. My VA sleep Dr saw the settings and sleep reports on my machine that I got from these two pages and said: Good job!

"Well, The vast majority of routine uncomplicated apneas found in a patient in an in lab study. (Like me) Were sent home with a pap machine that was set at the factory 4cm-20cm setting."

How exactly do you know what settings the vast majority of diagnosed uncomplicated apnea patients are using? I most certainly was not sent home with those standard settings after my lab diagnosis.

My doctor is selective of who she works with for sleep clinics. Her #1 gripe is that MOST (she 100% said most) sleep doctors/clinics just send people home with basic settings and at best check to see if your AHI is below 5 after a couple weeks and again at maybe a few months. They aren’t fine tuning, they aren’t being proactive, they’re slapping everyone with basic default settings and billing their insurance as long as their AHI is in the “treated” range. This is straight from my doctor, who is even more frustrated with the medical system than I am. Not everyone has great doctors.

I think the bigger issue is that a lot of commenters here are basing their arguments around everyone having the same great doctors and medical insurance they do. Not everyone has that. The prescription requirement alone prevents a lot of people from being treated because they can’t afford literally thousands of dollars out of pocket when they can’t even afford to eat.

It was mentioned that Medicare won't pay for a Wheelchair without a Script, and the same would, no doubt, apply to CPAP machines and supplies.

As far as I know, Medicare will not pay for anything that is OTC. They require a script in order to reimburse.

I believe requiring a Rx for these item probably does cut down on dishonesty and fraud.

Plus, where would they draw the line? Will Medicare start covering Aspirin, cough syrup or Band-Aids since they are OTC ?

Just like you can purchase some medications with just the pharmacist's approval/assistance, it seems like a home assessment and CPAP could be approved with the assistance of a Respiratory Therapist. The basic evaluation and prescription does not seem to need a physician's review. Now, if the RT finds something other than routine OSA, they could refer or recommend the patient to a specialist.

pratzert wrote: ↑

Tue Apr 15, 2025 10:40 am

Will Medicare start covering Aspirin, cough syrup or Band-Aids since they are OTC ?

My Medicare Advantage Plan allows $108 per quarter for OTC.

I only have Original Medicare and an Employer Sponsored supplemental plan which has a steadfast rule that they only cover items that Original Medicare covers.

They only review and allow claims that have been processed by my Original Medicare Plan.

To my knowledge, Original Medicare, Part B, does not cover any OTC items.

This is the Quote Directly from "Medicare.Gov": "Medically necessary services: Services or supplies that meet accepted standards of medical practice to diagnose or treat your medical condition."

The "supplies" they reference are generally DME supplies.... wheelchairs, Canes, crutches, Oxygen, CPAP & supplies and other items which still require a Prescription or written order from a Doc.

Medicare Advantage Plans and some other supplemental plans may cover OTC items.

Sadly, the plans "I" have do not..... :.(