I have been purchasing test strips and lancets from a CVS pharmacy; Medicare part B pays for these items. Medicare will pay for 100 strips/lancets per month or 300/90 days. There is an exception if your physician writes a prescription for a greater quantity. However, effective Jan. 29, 2019, CVS will no longer process prescriptions for quantities in excess of 100/month or 300/90 days. CVS’ new policy is due to the cost of the audits for the “excess” quantities. Has anyone else encountered this at other pharmacies? I am researching other brands of blood glucose meters to find less expensive strips and also checking with other pharmacies to see where an “excess” quantity prescription can be processed. (CVS did not inform me of this change until I attempted to re-order my supplies.)
I dont know about excess strips but I am familiar with the CVS advanced strips and meters. If that is what you have I believe they cost 20 cents per strip over the counter. Not covered by insurance. 20 cents is at the low end of the cost scale.
My Medicare advantage pays for one touch ultra stips just not that many ( two strips a day so I supplement with the CVS advantage. I find the results are consistent between the two types.
I saw a review of strips and CVS advanced was one of the preferred choices, based on accuracy and cost.
Lynn17: If you are on medicare, have you considered going on a CGM? Medicare covers 100% of CGM expenses including sensors, transmitters, receiver, test strips, test solution, glucose meter, battery. And you get it all delivered monthly to your door via FedEx. Maybe you are not interested, but just a thought in case you were not aware Medicare covers 100%.
Same thing happened. Was getting 800 a month and CVS had only 200 or 300 for me this month and said Medicare doesn’t allow more. Then talked to in-charge head of pharmacy who agreed it makes no sense and said she would look into it. Called back and said if you have a prescription for more that is ok but otherwise no. So you probably got a pharmacy assistant. Try again.
Thanks for your response. What supplier do you use to get monthly delivery? I have a DexCom G5; I do at least 4 blood glucose tests/day. The cgm readings are not accurate enough for me to dose insulin from them. I tried to purchase my G5 using Medicare benefits the first year the DexCom was Medicare approved. I spent 2 months trying to get one—the supplier kept telling me it wasn’t covered by my supplement and would not submit a claim, so I could not use Medicare benefits. The receiver I purchased is a G5, but different than the one you get via a Medicare claim. At that time, at least, Medicare covered 80% of the cgm and sensors. I have a Medicare supplement that covers the cgm and sensors without using Medicare guidelines, I pay 20% and can get whatever quantity of supplies I want. (I had a G4 prior to going on Medicare and paid full price for supplies.) Medicare covers 100% of my test strips and lancets, but the issue I have now is that CVS won’t process the prescription for more than 300 strips. I’m using One Touch Ultra strips, which are very expensive, so I’m trying another brand. I can get 300 strips of the new brand at no cost under Medicare and can buy 100 strips for less than $30 on Amazon if I can’t find a pharmacy to process a prescription in excess of 300 strips for 90 days.
Thanks for your response. Good to know about the CVS strips. My CVS pharmacist has not mentioned them. I talked with my diabetes educator about this issue and am trying a Contour Next EZ meter; the strips are less than $25/100 on Amazon. My major frustration is CVS’ new policy of not processing prescriptions under Medicare for more than 300 strips for 90 days for a T1D. (Medicare allows any brand of strips apparently)
Medicare covers our G5 and 300 strips PER MONTH; not for 90 days. Perhaps you need to look into Dexcom! Our strips come directly from Dexcom and we (my wife and I) have received our February shipments with 300 strips along with sensor, for ONE MONTH. That is 3X the limit you are describing regarding CVS/Medicare.
Hi Lynn17
You are going through an awful lot of trouble you should not have to. Your endo should set you up directly with Dexcom. If he/she can’t do that, contact Dexcom directly as I believe they can initiate the process as well. Getting 4 strips a day or more from Dexcom is no problem. The Contour Next is what you will get directly from Dexcom included in start up package. I used to be on One Touch Ultra strips from the day they came out until I went Dexcom and hesitated going to new strips/meter but have found the Contour Next much,much more accurate than One Touch. I only test twice a day 8AM and 8PM to calibrate G5 (less is more) as I find more calibrations renders the algorithm less accurate. Even if difference is 40 between finger and CGM, I don’t adjust CGM except 8AM and 8 PM and find that within a few hours CGM and finger stick are back dead nuts on. You just need an endo that knows how to properly fill out the form for Medicare and that will save you mounds of time and troubles.
rcaril: Omg. I spoke with 3 different people in my CVS pharmacy, the last one being the pharmacist who explained CVS’ new corporate policy of adhering to the rule of 2 strips/day for T2D or 3 strips/day for T1D. This policy started Jan 29, 2019. Medicare DOES allow more, but CVS’ new policy is not to process those prescriptions. (I was getting more than 300/90 days, too; my current prescription amount exceeds the 300). “My” pharmacist is very knowledgeable & extremely helpful (she’s the one who got me set up to order test strips using Medicare instead of my supplement). Apparently CVS’ software won’t allow pharmacy staff to process a prescription for more than 200/300 for 90 days now even if your Rx is written for a higher amount. (Let me know if you’re able to get a larger amount on your next fill at CVS!) I’m pharmacy shopping in the interim. This is insane!
Dav44: Did you purchase your G5 under Medicare? (I couldn’t get that to work). I do have a G5 (but not the Medicare style receiver). I quickly looked at DexCom’s site, but didn’t see anything about blood glucose test strips. DexCom has never mentioned them to me—I will be calling them on Monday. Thanks for the heads up. (this forum is very helpful!!) Nice to hear that you and your wife are getting your supplies without mega headaches!
Thanks for the info on the Contour meter/strips via DexCom. Interesting that that’s what DexCom supplies. My endo has not mentioned anything about working w/DexCom. Neither has my diabetes educator. I totally agree with you on calibrating the G5 only 2x/day and how the G5 and bg will sync. Only have 1 endo in my community at the moment. Mayo Clinic is supposed to be opening a facility here in next year or 2, so am hoping for more options and knowledge. thanks again
Lynn17
This FAQ should answer most of your questions about Dexcom Medicare CGM coverage and be helpful for you and your endo to read before processing paperwork because if Medicare paperwork does not exactly reflect the requirements in this FAQ, then you could be rejected.
CJ114: Thanks for your repsonse and the FAQ. I’m a long time DexCom cgm user and waited patiently for the Medicare approval to happen. I tried 18-20 months ago to get a G5 under Medicare guidelines. I met all the requirements; all requested documentation was submitted. DexCom was unable to process claims for my plan at that time. The durable medical equipment supplier I contacted (Byram HealthCare) said my plan didn’t cover CGMs and refused to submit a claim to my supplement. (And they stopped answering my calls and emails; nor would they answer calls from my supplement company.) Apparently there was/is a snafu in the Medicare system regarding cost plans and advantage plans that I couldn’t untangle. (I didn’t even get a chance to be rejected, lol). Neither my endo nor my diabetes educator seem knowledgeable about working with DexCom. I plan to contact DexCom Monday.
Don’t get tangled up in plans. Dexcom Medicare is a direct program with medicare. As long as you have Medicare Parts A&B, that is all you need as far as I know. You should not need any third party provider. Mondays are always busy at Dexcom so plan to be on hold for sales department up to 30 minutes.
Do you have Supplement or Advantage? I read G5 not yet covered by Advantage plans.
I think this is where the problem lies. Medicare/Dexcom appears to have been in a turmoil period just about the time you were trying to get yours.
See attached articleOrdering Dexcom Medicare
I have been getting 800 test strips a month forever under Medicare and supplement. We just fill the prescription at CVS. Other than this month, which has now been corrected, we just give the prescription to CVS and they provide the test strips. It seems unrelated to having a Dexcom G5 which I have. Just make sure your endo prescription is up to date and you talk to the head of pharmacy at CVS. Worked out ok for us after the earlier glitch this month. Good luck.
I got very frustrated at having to jump through hoops (and ask my doctor to do the same) for more than 100 strips per month. I use a True Metrix meter specifically because I can augment what I get from Medicare on Amazon. The prices are really good, and they are just as accurate as the better known meters.
Your doc shouldn’t have to “jump thru hoops” to get you an Rx for whatever amount you can verify with your logs from your meter(s). I’ve never had any problems getting 800 or so strips per month, then down to 600, and finally down to 300, currently thanks to using a CGM. Something is wrong with either your doctor’s attitude, or his staff, if its a big deal to get the Rx quantity of strips that you need. I’m serious! I’m talking decades of experience with this, multiple doctors, and numerous insurance, including Medicare.
My endo has written the prescription for the number of strips I need. I have the logs to document the number of tests I do and my endo downsloads the data from my blood glucose meter to verify testing. It’s the pharmacy—CVS—that is causing my frustration. They will no longer dispense more than 300 strips for a 90 day supply under Medicare., even with the correctly written prescription.