My pharmacy has just labeled me an “over-utilizer” because I test about 8 times per day and use Contour Next test strips with my pump and sensor. The Medicare limit is 3 test strips per day unless the “excess” testing is justified with every refill.
Why does Medicare not understand Type 1??? Just to get my pump I had to prove I would test at least 6 times per day. This is unbelievable. I told the pharmacy rep that the label “over-utilizer” was offensive. My endo is great, but there is no reason that he should have to spend his time (or pay someone else) to respond to this nonsense.
Here is the email that I just got from the mail order pharmacy:
Medicare changed their guidelines and the amount of testing strips they would pay for as of July 1st 2016. Medicare decided to pay for 300 testing strips every 90 days if you are insulin dependent and 100 testing strips if you are NON insulin dependent. Medicare requires additional documentation in order to pay for more than the maximum amount of testing strips they are paying for.
Below is the information on what Medicare’s new guidelines are and what they are now requiring in order for you to test your blood sugar more than X times per day.
Medicare wants the following documentation for every refill:
Your office visit notes are the most important******* Please read the information carefully and ensure that your doctor adds the sentence that Medicare is looking for.
#1. Medicare needs the last 2 doctor visit notes (must be within the last 6 months) AND THEY MUST STATE under the PLAN or ASSESMENT section; the specific amount of times you need to test your blood sugar, the reason why, and for how long. IF THE DOCTOR VISIT NOTES DO NOT CONTAIN THAT INFORMATION YOU NEED TO HAVE THAT UPDATED ON YOUR NEXT APPOINTMENT.
An example sentence would be: +++++++ patient needs to test his blood sugar ___times per day due to uncontrolled blood sugars. needs to continue testing at ____ per day for the next 3 months ++++
#2. Medicare needs to see A 30 day consecutive testing log signed and dated by YOU AND your physician on the last page. (IT MUST BE A testing log from within the last 3 months).
#3. Lastly Medicare also needs to see your testing log signed and dated by your physician and they need to see a copy of your A1c lab report.