BC/BSTX doesn't cover FreeStyle test strips anymore

My insurance (BC/BSTX) doesn’t cover Omnipod’s FreeStyle test strips anymore. I’ve enrolled in the FreeStyle Promise program but was wondering if anyone else had thoughts on what my other options might be?

We appealed this when our insurance made this decision. We have to reapply every year, but since it’s “the only strip that works in my son’s pump,” they allow it. Freestyle isn’t the cheapest strip, so for other people they require the cheapest ones. It might be worth finding out if they are flexible in “extenuating circumstances.” I just called to re-apply again for this year and told them that since my son hadn’t been cured yet we would have to re-apply again this year . . .

That’s a really good idea Natasha. I remember switching strips and being shocked when the pharmacist gave me the bill. I had been using the one touch ultra strips which bc/bs also took off their preferred list just as I switched to the omnipod. Now everything has gotten much more costly. I’m in the freestyle promise program but, my goodness, they are still far more expensive than any other strip I’ve used. So what exactly should I do? Is there a certain section of bc/bs that I should talk to about “extenuating circumstances”?

In my state the Doctor writes a letter to your insurance company explaining the situation (you may also try just calling the number on your insurance card and asking some questions but I can’t promise you that you will be talking to someone who knows anything). A large insurer in my state prefers Bayer products but makes an exeption for anyone who uses a meter in conjuction with a pump.
If they still deny you keep appealing. If you are a thorn long enough they may just give in.
If you get tired of messing with it you can always switch to the meter they want you to use. I know it would be less convenient but when it comes down to money I am cheap like that :slight_smile:

I’ve already gone round and round with them (insurance). They said they are phasing out strips altogether (eventually) and we have to go through CareMark. I’ve talked to CareMark MANY times and they aren’t budging. I’ve considered using a different meter for testing, but it’s just another bulky think I have to carry around with me.

Reapply for what? How and what do I say to the insurance company to do this?? Of course, in the numerous times I’ve called them, they never told me to reapply for anything, or that it was even an option.

I ran into this problem when my BCBS plan stopped covering Humalog Insulin (they only approve Novalog now which I am allergic to). I got around it by ordering my insulin (and test strips, etc.) with my insulin pump supplies. It’s all billed as durable medical equipment now and therefore not subject to pharmacy approved medication lists. I’m really hoping that they never catch on that this is how I get around it but it’s working for now. I don’t see why it wouldn’t work for strips too.

I have an Animas and the Ping takes One Touch.
My HMO tried to send me one Accuchek meter. Gee, thanks.
I simply told the doctor he had to write for One Touch, he got an authorization (one time only) and wrote the prescription and they never questioned it again. You have to have strips for the pump you are using and usually they will approve it.

Cerificate of Medical Necessity is what you need you doc to fill out. That will get the ball rolling on having an actual doctor from the insurance company look at the request. I think the people you have had tell you no so far are just the folks answering the phones.

Thank you! I’ll check this out.

Be sure to call Abbott labs, the makers of the Freestyle devices, as they will most likely lend a helping hand. Good Luck, and PEACE

I called Abbott. All they could do was get me enrolled in the FreeStyle Promise Program, which I was already enrolled in. Oh well…

Really, just call the doctor.
If you have to have X strips because your pump uses X strips with the matching meter, they usually will do it with the doctor’s prescription or authorization of some type.
I’m telling you, all I did was tell my HMO I am not accepting one Accuchek meter when I have (I think it was a Cozmo at the time) a pump that needs Freestyle strips.
They said ok, and took his prescription and covered it. I dont remember if he even got involved.
You can also ask you local rep what to do, they may also be able to help.
Dont take no for an answer…keep working on it.

I am a cheapskate. I buy the reli-on micro test strips for $36.00 for 100 strips.
My insurance requires mail-in prescriptions and they will not process the freestyle promise program so it comes out cheaper for me to buy the wal-mart brand.

This whole thing is frustrating. Inusrance companies are better off if diabetics are monitored so as to prevent problems in the long run. I just got the pod and am hoping they don’t quit paying for my Freestyle strips. I haven’t checked the price without insurance, but even my co-pay was $20 more than with the One Touch.

Mine won’t process the freestyle promise program either. I have contacted my doctor, abbott, omnipod, BCBSTX and Caremark. I’ve told them I have to have Freestyle with the Omnipod. BCBS says it’s Caremark’s problem. Caremark refuses to pay "it’s not covered under our “preferred test strips”. I’ve had my doctor fax in a request. They are still refusing (after saying they didn’t receive the fax 2 times). I’m about to erupt. I think my best option may be to get a cheap meter with the cheapy test strips and just manually input my numbers into the omnipod meter. BOTHER!!!

Patra, did you get to speak to a person at Caremark? Just curious, and I dont remember if you said.
I would ask for a supervisor and say just what do you expect me to do if those strips go with my pump?
No use making yourself sick and stressed over this but it surely helps to be able to use all the funtions of your pump.
I’m hoping the best for you!

Do you know if Freestyle will alloow you to submit receipts to take advantage of their Promise program?
I also have Caremark. The way it works for me is:
Accu-Chek and One Touch are their preferred meters. If I use one of those meters I have a tier 2 copay. If I use another meter it will be tier 3 copay. I was wanting to take advantage of a similar program to Promise Accu-Chek has. I called Caremark and they said they will not take the card. I called the Accu-Chek number and they said I can submit my receipt and they would send me a check for the difference. I am wondering if you can just pay the higher copay to get the Freestyle stips and submit the receipt to Freestyle and get the cheaper copay?

I was flat out denied any co-pay by Caremark - never mentioned anything about a Tier 3 copay. I also talked to Abbott and they told me simply using the Freestyle Promise card would make the cost somewhat lower and that it didn’t need to go through insurance. I haven’t tried this yet. I’m about to head to the pharmacy. I’ll update you on what they say.
I did speak to a person at Caremark, as did the pharmacist that was helping me. A flat out NO was the only answer we both got. I’m going to check in the the Tier copay thing.

Keep us posted!