Medicare to Cut Ostomy Suppliers to 8 Contracts: What Patients Need to Know

The rehabilitation facility had no ostomy supplies for her. She had not brought her own supplies with her on the way to the facility because she was new to living with one, so a plastic bag was attached to her abdomen with Scotch tape.

The woman, a patient with cancer whom Ellyn Mantell had been supporting, developed sepsis, a life-threatening reaction to infection.

"She became septic, and she died," Mantell said. "She never even had a chance to fight the cancer."

Mantell has lived with an ileostomy for more than a decade and serves on the patient advisory board of the United Ostomy Associations of America (UOAA). Many of the people she mentors after cancer surgery call her before they call their ostomy nurse or their doctor, and for each individual, the right supplies decide whether they can leave the house.

"The minute those supplies end, we will not be able to leave our bathroom," she said.

In November 2025, the Centers for Medicare & Medicaid Services (CMS) finalized a rule that adds ostomy and urological supplies to Medicare's competitive bidding program for the first time. The program awards contracts to suppliers that bid the lowest prices, and the change will move ostomy supplies to eight national contracts, which advocates say would replace the hundreds of distributors patients can order from now. The new contracts are set to take effect Jan. 1, 2028. Ostomy and urological supplies are fitted prosthetics rather than interchangeable goods, and that losing the right fit can lead to leaks, skin breakdown, infection and hospital stays according to Mantell.

Why are ostomy supplies fitted to each patient with cancer?

An ostomy is a surgically created opening, called a stoma, that lets stool or urine leave the body through the abdomen into a pouch. Patients with colorectal, bladder and gynecologic cancers often need one, either for a short time or for life.

"Maybe a third of my patients or more have diversion of their bowel or bladder related to cancer diagnoses," said Kate Lawrence, a wound, ostomy and continence nurse in Vermont.

Lawrence explained that the body changes over the first six weeks after surgery as patients move around more at home, and anatomy can shift again with weight gain or loss, a hernia or pregnancy, each of which may call for a different pouch.

"It's sort of like getting different shoes for different reasons, based on your activity and your lifestyle and how your body is changing," she said.

For instance, Mantell is not quite 4 feet 11 inches tall, and one of her friends with an ostomy is 6 feet 4 inches.

"We can't possibly be wearing the same size," she said.

How does a patient learn to manage a new ostomy after cancer?

Bern Paul had just finished a workout at the gym when he saw blood in his urine. Within about two weeks, in April 2024, the then-68-year-old was diagnosed with stage 2 bladder cancer that had grown into the surrounding muscle.

He received four chemotherapy treatments over two months, and testing afterward showed no remaining cancer. His bladder still had to be taken out, and surgeons removed his prostate with it. A biopsy of the removed prostate also found cancer. His surgeon created an ileal conduit, a passage made from a piece of intestine that carries urine from the kidneys to a stoma, leaving him with a permanent urostomy.

Paul went home with a few product samples. A home nurse came once, but a language barrier made the visit hard to follow, so he taught himself.

"I learned everything on my own and figured it out," he said.

He learned through leaks, through waking up to a wet bed and through standing up from a restaurant table to find his clothes wet. He also found which products his skin tolerated. Today he keeps a tray of close to 10 products from several manufacturers, a mix of adhesives, powders, sprays and pouches he built over two years with his doctor and an ostomy nurse.

"It is not a situation of one size fits all," Paul said. "Each person is an individual."

Then he met Mantell at a UOAA conference in Orlando, Florida, where the two ended up sitting next to each other at a restaurant bar and she soon realized his appliance no longer fit.

"The stoma kept getting smaller, so he was leaking around the pouch," Mantell recalled.

The next day, a nurse at the conference's stoma clinic fitted him with a better appliance. The new appliance allowed him to move more freely: He rides his bicycle, swims in the Gulf of Mexico in a swim shirt and boards cruise ships out of Tampa.

"I'm not surviving. I'm thriving with it," Paul said.

What can happen when an ostomy pouch does not fit?

When a pouch leaks, stool or urine sits on skin that was not made to hold either, Mantell explained, and causes blisters and pain. Once the blisters open, infection can take hold.

Years ago, Mantell tried a different brand’s product on a recommendation from her doctor. While she waited for a friend at a restaurant, she could feel her pouch filling.

"I looked down. I was covered with stool," she said. "I sat there the whole time just fighting tears."

Dr. Diego Schaps, a general surgery resident at Duke University Hospital and a member of UOAA's advocacy committee, compared the pouching system to a prosthetic.

"It takes us a while sometimes to find the right one," he said. "Oh, but when we do, it's magic. People can live their lives, and it's awesome."

When a pouch fails, Schaps added, patients may need more emergency department visits, more appointments with their ostomy nurse and surgeon, and in some cases procedures or hospital stays.

What is Medicare's competitive bidding change for ostomy supplies?

Ostomy supplies have been covered under Medicare Part B's prosthetic device benefit, and advocates say Congress deliberately kept them out of competitive bidding. The final rule, published Nov. 28, 2025, interprets the law to treat ostomy, tracheostomy and urological supplies as medical equipment that must be included. CMS has said the program is meant to lower Medicare spending and cited rising Medicare charges for all three supply types. The agency also says the program includes a safeguard that lets beneficiaries get a specific brand when it is needed to avoid a harmful medical outcome, though UOAA has said it remains concerned.

Schaps read the more than 700-page rule and found one sentence in support, which concerned rising spending on one type of supply.

"I was disappointed by the stark lack of evidence supporting inclusion of ostomy supplies into competitive bidding," he said.

He acknowledged that his concerns come from what he has seen when patients switch to pouches that may not work for them rather than from proven outcomes. At the very least, he said, CMS should pause and bring surgeons, nurses, economists, patients and advocates into the conversation to study how competitive bidding could affect patients.

Mantell sees the savings as a trade-off within Medicare: Part B pays for ostomy supplies, while Part A pays for the hospital care that follows when skin breaks down or an infection develops.

"They've robbed Peter to pay Paul," she said.

Competitive bidding is meant in part to curb fraud and abuse, but Lawrence said she and her colleagues have found little evidence of fraud in ostomy supplies, and CMS has not clearly defined its concerns about overuse.

"We may be using a hammer when we could be using something softer," Lawrence said.

How could fewer ostomy suppliers affect patients in rural areas?

In Lawrence's home health work, rural delivery is already unreliable. Carriers that cannot reach a home, she said, will leave the box at the end of a long driveway in the middle of a snowstorm. Many of her older patients are not comfortable ordering online and rely on local suppliers who know their circumstances.

She is now working through a problem with a national distribution company that has the wrong number of pouches on file for a teenage patient with Medicaid.

"I have spent at least six hours on the phone so far, trying to get it fixed," Lawrence said. "This petrifies me that this might be the scenario of what's going to happen to my [patients with] both Medicaid and Medicare."

Mantell questioned whether a handful of contractors could keep up with demand nationwide.

"There are a million of us in this country alone," she said. "How are eight distributors going to get us our supplies every month?"

Paul has switched suppliers once for insurance reasons, but changing manufacturers, he said, would mean starting over.

"I need the continuity and the consistency of what I'm using in order to maintain my health and my independence in the community," he said.

What can patients with an ostomy do before the Medicare changes take effect?

Lawrence advised patients to bring a list of their supplies to whoever writes their prescriptions, which is often a primary care provider rather than the surgeon, and to make sure the medical record notes the type of ostomy, why they have it and how they are doing. A clear record, she said, can help justify supply orders.

She also directed patients to the Keep Them Out petition from the ITEM Coalition and to education pages from UOAA and the Spina Bifida Association. UOAA is asking advocates to urge House members to co-sponsor the Access to Medical Supplies Act (H.R. 10787), which would delay adding ostomy and urological supplies to competitive bidding.

For lawmakers, Schaps said, patient voices carry the most weight.

"I could say a million things as a resident surgeon, but it's the patient stories and the people at the forefront that are the most important," he said.

Paul rarely shares the details of his ostomy, even with friends. He chose to show his products on camera because of what Medicare's bidding change could mean for him and others who rely on the supplies.

"I'm not a salesperson; I'm an end user of these products," he said. "I've come out the other side, and I don't want to go back and start having problems now."

References

1. "CY 2026 Home Health Prospective Payment System Rate Update and DMEPOS Competitive Bidding Program Final Rule." Centers for Medicare & Medicaid Services. Posted: Nov. 28, 2025.
2. "Understanding the Medicare Competitive Bidding Program 2025 Ruling." United Ostomy Associations of America. Accessed: Oct. 30, 2026.
3. "CMS Finalizes CY 2026 DMEPOS Competitive Bidding Rule." Wound, Ostomy and Continence Nurses Society.
4. "CMS's DMEPOS Competitive Bidding Program Redux." DLA Piper. Posted: Dec. 18, 2025.

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