Greetings!
Our health insurance is changing to Cigna next year and Freestyle strips are considered Tier 3 (non-preferred Brand) by them. Even after the $50 Freesytle Promise coupon, these strips will be very expensive for us. Has anyone been able to get CIGNA cover them as Tier 1 (generic) or Tier 2 (preferred brand-name) since they are to be used with Omnipod?
Thanks for your responses.
I had the same problem with BCBSO (pre-Obamacare, when I didn't have a choice) and just gave up and used their preferred brand (Bayer).
Other people have reported that if the doctor prescribes the Freestyle strips and writes a certificate of medical necessity for the insurance company they will be covered. I can't remember if that was for Cigna though.
You can also buy Obamacare compliant insurance yourself, but this works out at about $1000/month (premiums+deductibles+copays) in practice, for an Omnipod user, so isn't normally cheaper.
I dont havE Cigna, but ran into the same thing…HOWEVER…my old strips were tier 2 and I got one hundred per refill. The Freestyle are tier 3, but they give me TWO hundred per refill, so they actually turned out to be slightly cheaper for me in the long run.
Even if I had to pay more, I’d be willing in order to keep my omnipod…overall it just works great with my lifestyle.
Good luck!
I think we are in tier 3, too, but with my coupon, I pay about $25 for 200 - so we are okay with that. It was great when Omnipod had the problem with the strips and sent us like 400 free, wasn't it??! :)
I had the same tier 3 issue with United Healthcare. My copay was going to be $300 for 3 mos. of freestyle strips. But my medical supplier found a way around it. Instead of going through the RX to get the strips, they filed it under DME (durable medical equipment) and I only had to pay 10% (my coinsurance) which was $30. I highly recommend using a medical supplier for all your diabetes supplies. They really know how to work the system and get the best price for you. I use EdgePark Medical but there are many others. I also get my pods and CGM sensors through them.
That's the correct way to do it for Medicare; all pump supplies (insulin, test strips, cannulas etc) are DME according to the Federal Medicare rules.
You're the first person I've heard of who has had success with this and it's been a consistent problem for people covered under Medicare; the Federal rules are totally unambiguous, but the various private companies that handle coverage don't seem to understand them. (Which can only mean they haven't taken the time to read them.) Good to hear that EdgePark have finally been able to afford a pair of reading glasses.
Of course for everyone not under Medicare the insurers effectively still write their own rules. However logically Medicaid and Obamacare should be using the same rules and, so far as I can see, it doesn't make any sense for insurers to invent their own rules unless they only provide employer insurance.
John Bowler
Just want to clarify that I am NOT on Medicare. My UHC coverage is through my employer. We have a pump support group here & there are several others who are utilizing a medical supply company to get their diabetes stuff. All of them were surprised as I was that these companies seem to know how to get around RX copays.
Yeah, I figured; it sounds like Cigna have given up on their own hand-scribed rules and are using the Federal ones. This is good; we can vote for the government, we don't have any choice about our employer's insurance company.
So how do we go about using a medical supplier for our supplies? I don't know if it would help us - because our coinsurance is 20% and right now, with a coupon, I can get my prescription filled for about $25 (but that's only a month's supply. But I don't use one at all - and we have United Healthcare for our prescriptions but Aetna for our insurance. But I wouldn't mind looking into this. Thanks!
Potentially you can swap all the Omnipod supplies (including insulin) to Aetna, but unless you are on Medicare you face the very real possibility of Aetna and United Healtcare having two different set of rules which mean neither of them are responsible for anything.
In any case, this is the first time I've heard of anyone managing to get any company accept that DME supplies are DME supplies ;-)
Incidentally, I'm currently paying $30/30 days for test strips (300) on prescription. The price Walmart is charging for these is $467 (i.e. $78 for 50), so even though my DME coinsurance is (IRC) 10% - $46.70 - I'm still ahead on the prescriptions; $16.70 a month to spend on those candy bars. Since this is an obamacare plan it doesn't make any difference to me whether I pay a "co-pay" or a "co-insurance" and since I won't max out I'm better off with the $30 "co-pay".
There is no choice but to ask all the questions and do all the math.
John Bowler
Sonya, just call one and see if they can help. It won’t hurt to try & they will find the best way to file it with your insurance to save you the most $$&, whether through copays or coinsurance. They will even contact your Dr for the scripts.
Yes, I have Cigna and they cover the strips at 100%. As jbowler stated, they just needed a letter of medical necessity from my doctor.