I have made posts on many sites about the bill that would require Medicare to cover CGM’s. That bill may never be considered unless more Congressmen/women and Senators support the bill. Many of my friends knew that I had not used a CGM for several years, because my insurance changed, and Medicare turned down my request for a CGM. My endo sent Medicare a letter of medical necessity (I have some hypo unawareness), but my request was still denied.
In the Joslin Medalist group on Facebook several medalists have mentioned that they have hypo unawareness. I have that problem sometimes, and cannot feel a low until it drops into the low 50’s. I have read that type 1 people are more apt to experience hypo unawareness when they are older. It seems that people who are older, and on Medicare are less important, and can be denied. This is so unfair!!
Life has no guarantee that it is “fair”. Besides, what is “fair” to one person, may not be so to another. I would love for Medicare to cover CGM, but it is what it is…for the time being. ANother time, things may improve, regarding Medicare. Fingers crossed.
… but (please excuse my rant) does that mean we should just lie down and let Medicare regulations that were promulgated before CGMs were widely used and accepted by private insurers stay as they are? Perhaps we should move to the back of the bus?
Does that mean that if a law is being proposed that will correct an unfair situation, that we should just keep our mouths shut and hope and pray that our elected representatives will somehow read our thoughts (or rely on a highly paid lobbyist) and co-sponsor/vote for something important? Let the Fates decide!
Does that mean that as CGMs become more integrated into insulin pumps and pumps evolve into effective artificial pancreas devices, that we should relegate our senior citizens to a second class status? Or that we should demand that pump manufacturers maintain non-CGM pump technology for seniors on Medicare? #SeniorLivesMatter
If among the roles of Government are “To establish justice” and “Promote the general Welfare” isn’t enacting legislation that corrects what effectively is an unequal treatment of senior citizens a proper function of Government?
LOL! You do agree with the fact that life isn’t fair, at the onset of your post, and then attempt to somehow make “fairness” a “right”. As a senior, I learned a long time ago that life just isn’t “fair”. If life were fair, when I’m in the commute lane, there wouldn’t be a 40% rate of cheaters (I’m not making that up–it’s been in the local news) to clog up the lane. I could go on and on and on, wringing my hands in righteous indignation about all the things that aren’t “fair”, but it would be a pointless endeavor. Again, what is fair to on person, may seem equally unfair to another, so I don’t agree with your premise that there are laws that you see needing to be enacted, out of a “fairness doctrine”. It all comes down to negotiations, costs, and other factors. “fairness” is but a drop in the bucket of the reason why laws are made. And even when made, they aren’t carried out in “fair” fashion, at all times, and many laws aren’t enforced at all. Those who want such laws enforced would say,“but that’s not fair!!!”. whatever.
if everyone took that attitude, we would be ruled by warlords. we don’t have perfect system now, but we have the structure in place to attempt to make ‘a more perfect’ system. it’s up to the individual if they want to participate in that structure (ie voting, public protest, etc). if you have a low tolerance for conflict and frustration (like me), you will participate less or not at all. we ride on the coattails of the people who fought for our rights.
YogaO and v_prediabetic, thanks so much for your points of view. There are many supporters like you online. The younger folks supporting the senior citizens is good to see!!
I agree completely that everyone who needs a cgm should have the ability to get one. As long as we accept the model though that some other entity; insurance, Medicare, Medicaid, whatever, must pay for something… It means we’ve simultaneously accepted the model that it is and should be more expensive than is affordable to an ordinary person. If we accept that, we’ve already lost. Don’t confuse that statement with thinking there shouldn’t be safeguards in place to ensure that people who can’t afford certain things still have access to them–There must be… But when we expect the standard order of business to be for someone else to pay for everything everyone else needs… well, we see what we get— conflicts of interest, runaway prices, and limitations to access.
The only way to win this one is for prices to come down to levels where ordinary people can afford the medications and devices they need without social programs—
As long as somebody else is paying for something there will always be conflicts and the laws of supply and demand will never work correctly to keep prices in check. This concept is the largest failing of the entire USA medical system.
Sell advertising on pumps and meters…keep cost down…like the little VW running around with GEEK squad on it. I would wear advertising…it is all around us
I heard the reason Medicare doesn’t cover these is simply the coding, it’s considered disposable durable goods, same with Omnipod, that’s why they’re not covered. Has nothing to do with FAIR or anything else. It’s the coding. If we didn’t stand up and sound our voices and fight for what we believe in then laws would never get passed and the people we want in or out of office would or wouldn’t be there. Silly to even make comments such as 'some things are just not fair in life,"
I believe people on medicare (retired) have paid their share already. This has nothing to do with government programs or people who can’t afford them, it’s medicare. if you don’t want to collect your SS when you retire and the benefits, then don’t.
IMO, fair isn’t the issue. The right to standard care is. The cgm is standard care for those with certain problems with diabetes. For example, hypo unawareness.
Furthermore, I know that many on Medicare live alone. There is no one to insure they don’t go into a coma due to either hypo or hyper. To me, that is a survival issue. I am fortunate to have secondary insurance that covers cgm (yes, federal BC) because without it I would be either dead or have even fewer brain cells than I do now.
But then, I believe in good insurance for every citizen in our country. I am radical that way. That would show respect and care for every citizen, not just those with money or lucky to have good insurance.
The reason CGMs are not covered is because it is considered an “adjunct device”. This basically means that because you don’t actually use it to administer/measure therapy, you don’t really need it. Put another way, Medicare basically says if you want to know what your BG is, use a meter. Plus, as long as the CGM can’t be clinically used to decide on dosage, it’s not a necessity.
I am missing some point, pardon the diabetic pun. The law of supply and demand? If you want me to get a point maybe use another paradigm. My body demands insulin in specific quantities. The amount required is difficult to determine. My body doesn’t demand more than it needs but an outside entity demands more than my body needs because that outside entity is ignorant of the amount required. The demand for too much insulin makes my body fat and weak. The entire system is broken. But let me speak now of supply. This is not related to my discussion of demand which is humorous as the subject is the law of supply and demand which in name implies a relation, the law of ghettos and poverty, the law of conflict resolution and non violence, the law of drinking and driving, the law of peace and social justice. I picked up my three vials of insulin and left them on the front seat. After running errands the pharmacy bag was gone. My supply, my endless supply had dried up. I called some insulin dependant friends who were able to offer me some spare. I called my insurance company who was not. This points out the need for love. Maybe the real law is the law of love. Thinking now of a question. Does the law of supply and demand apply to love? If it did then the more one demands love the smaller the supply of love. And the smaller the supply of love the more expensive? But one cannot buy love. One can demand love. One can supply love. The law of supply and demand is one is successful when one supplies and unsuccessful when one demands. Scarcity. That might be more productive to discuss. The scarcity of love is something we can all address. The scarcity of accurate dosing decisions is something we all fear.
you need to give a concrete example. i’m interested in your idea, but i don’t understand it. i don’t have insurance pay for my meter or strips. i buy the walmart relion brand which is cheap. so why are some diabetes supplies cheap and others expensive? what would it take for a cgm to drop in price? how much do they cost now out of pocket? can you buy them cheaper out of pocket from other countries?
Concrete examples are all around us. Why do you think your prime strips cost 1/10 as much as strips using the same technology that are paid for by insurance instead? The exact same strips I use cost $130 for 100 at my local pharmacy (where people bill them to insurance generally). I buy them direct online for $45 for 300— for the same exact thing!
Why the differences? Because in the case of religion prime and the direct purchase of my other low cost strips, the price has actually been set by the manufacturer competing for our business by lowering their price. When insurance is paying for something, what’s the incentive for a supplier, manufacturer, etc to lower their price? The incentive is only to raise the price because the demand is no longer connected to the price. It’s simple competition and when there is a middle man like an insurer the whole balance is thrown off and the natural price controls are out the window.
@YogaO that really doesn’t make sense. if that were the case, why do they pay for meters then or pumps but not omnipod, it’s the coding, I was told, because of the disposable medical device.
Here’s a link to an article that sheds some light on it. Fundamentally, you are correct in that there is a “coding” involved to bill anything on Medicare, but Medicare says that CGMs are “precautionary” devices and thus aren’t covered.
