CVS will enforce 3x/day Medicare test strip limit

I was just rereading your comment…“Doctors would practically run in one door and out another…” I guess that is how it got the name “Urgent” care. It’s really “In a Hurry” care…

I use One Drop which sends me as many strips as I want. The plan is cheaper than my co-pay so this works for me. I do have a dumb question tho. I test about 8-10 times a day usually. The person that needs 800 strips a month would be testing 26 times a day. Why is that many times needed? Is there a better option for you? Wouldn’t using a CGM work better? I’m just curious is all.

Dear MOOBM,

Wow, just love reading your posts. You disseminate such valuable information. Thank you. Thank you. Thank you.

I am very grateful for your time and effort in helping us.

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Many years ago, . . .
Before going on insulin and before going on Medicare, my doc wrote script for test strips as: test 2-3 times per day. Each month I got a box of 100 test strips with NO problem.

Suddenly, one day, a NEW pharmacist was on duty when I refilled my prescription for the test strips. She filled it for 50, not the 100. I told her I needed 100. She refused. Her reason, . . .100 was for more than a 30 day supply and she stated I had been committing insurance fraud. She said 3 x 30 was 90 so I could NOT get 100. I said that her math was correct, 3 x 30 was 90 but she was only giving me 50 and 50 was 40 short of the 90 in her calculation.

The fight was ON. Should I be shorted 40 or given 10 extra? She refused to budge. I called her supervisor, and continued up the chain of command until I called the headquarters. I got my 100 strips but it was a HUGE fight.

People that are NOT diabetic themselves do not take into consideration the dud’s, the need for extra testing when having a low, etc.

Hearing now that it is limited to ONE strip per day if not on insulin, I guess they are going to have to revamp their packaging on test strips. Most that I have seen come in 50’s per packaging so I guess they will have to start packaging in 30’s and 90’s instead of 50’s and 100’s.

To limit someone using insulin to 3 per day is absurd. When I have lows, I test every 15 minutes until I am in a safe zone.

Maybe when the “rule makers” become diabetics, we will get more reasonable rules.

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Big “YES!” to that.

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In their defense, chances are it has to do with Medicare and their audits. I cannot stress to you how insane they are. That being said, many test strips come in boxes of 25 too. I don’t see why she could have give you a 50 box and a 25 box. If your particular test strips didn’t come in that box size than I would think it would be appropriate to present you with that choice. (Explain to you that your meter only offers glucose test strips in a box of 50 or a 100 but Meter "X’ offers them in 25, 50, 100 and if you wished, speak to your provider about switching meters so that you could get a box of 25 and a box of 50. Granted it still isn’t a full 30 day supply but it would have at least gotten you closer).
Keep a log of your glucose. Many patients don’t keep physical logs anymore because there are functions on many of the meters that are better than the physical log book. For Medicare though, physical logs are helpful, if not essential. Make notes in the log too when you get a “dud”. Different pharmacies have different methods of handling Medicare and the test strip police but I would tell the pharmacy that you have been keeping the log to provide whomever may need it to justify your testing frequency or need to fill early or whatever and if that would be something that would be helpful to them and who should you provide it too…

I would speak with the provider prescribing the test strips. If you wish to test more frequently tell them so and tell them that each chart note must contain some of that verbage I gave above. (Also just because it says: ““Not every patient medical record will contain all of these elements; however, there must be enough information in the patient’s medical record to support the medical necessity for the quantity of item(s) ordered and dispensed” the chart note should have everything they list in it because of Medicare is so anal).

Bottom line, complain to Medicare or your senators.

Medicare has 10 regional offices.

Region 1:
Connecticut; Maine; Massachusetts; New Hampshire; Rhode Island; and Vermont
Regional office: Boston
Office of the Regional Administrator
JFK Federal Building, Suite 2325
Boston, MA 02203-0003
Deputy Consortium Administrator for New York/Boston,
Raymond Hurd 617-565-1188
Deputy Regional Administrator, Barbara Manning 617-565-1185

Region 2:
New Jersey; New York; Puerto Rico; Virgin Islands
Regional office: New York
Office of the Regional Administrator
Jacob K. Javits Federal Building
26 Federal Plaza, Room 3811
New York, NY 10278-0063
Deputy Consortium Administrator for New York/Boston, Raymond
Hurd 617-565-1188
Deputy Regional Administrator, Vacant
Director, Puerto Rico Field Office, Marina Diaz 787-294-1681

Region 3:
Delaware, DC, Maryland; Pennsylvania; Virginia; West Virginia
Regional Office: Philadelphia
Office of the Regional Administrator
Suite 9400, 801 Market Street
Philadelphia, PA 19107
Deputy Consortium Administrator, Nancy O’Connor 215-861-4140
Deputy Regional Administrator, Sharon Graham 215-861-4304

Region 4:
Alabama; Florida; Georgia; Kentucky; Mississippi; North Carolina; South Carolina; Tennessee
Regional Office: Atlanta
Office of the Regional Administrator
Atlanta Federal Center
61 Forsyth Street, SW, Suite 4T20
Atlanta, Georgia 30303-8909
Deputy Consortium Administrator for Dallas/Atlanta,
Lisa McAdams, M.D.
214-767-6423
Deputy Regional Administrator, Gil Silva 404-562-7150

Region 5:
Illinois; Indiana; Michigan; Minnesota; Ohio; and Wisconsin
Regional Office: Chicago
Office of the Regional Administrator
233 North Michigan Avenue, Suite 600
Chicago, Illinois 60601
Deputy Consortium Administrator for Chicago and Seattle, John
Hammarlund 312-886-6432 (Which is confusing because Seattle has it’s own office)
Deputy Regional Administrator, Verlon Johnson 312-886-6432

Region 6:
Arkansas; Louisiana; New Mexico; Oklahoma; and Texas
Regional Office: Dallas
Office of the Regional Administrator
1301 Young St. Suite 714
Dallas, TX 75202
Deputy Consortium Administrator for Dallas/Atlanta, Lisa
McAdams, M.D.
214-767-6423
Deputy Regional Administrator, Gerardo Ortiz 214-767-6423
Region 7:
Iowa; Kansas; Missouri; Nebraska
Regional Office: Kansas City
Office of the Regional Administrator
601 E. 12th Street, Suite 355
Kansas City, MO 64106
Deputy Consortium Administrator for Denver/Kansas City, Jeff Hinson 303-844-7481
Deputy Regional Administrator, Neil Thowe 816-426-5233

Region 8:
Colorado; Montana; North Dakota; South Dakota; Utah; and Wyoming
Regional Office: Denver
Office of the Regional Administrator
1961 Stout Street, Room 08-148
Denver, CO 80294
Deputy Consortium Administrator for Denver/Kansas City, Jeff
Hinson
303-844-2111
Deputy Regional Administrator, Diane Moll 303-844-2111

Region 9:
Arizona; California; Hawaii; Nevada; and Pacific Territories
Regional Office: San Francisco
Office of the Regional Administrator
90 – 7th Street, Suite 5-300
San Francisco, CA 94103-6706
Deputy Consortium Administrator, Gregory Dill 415-744-3501
Deputy Regional Administrator, Catherine Kortzeborn 415-744-3501
Pacific Area Representative for Hawaii and the Territories, Tom Duran

Region 10:
Alaska; Idaho; Oregon; and Washington
Regional Office: Seattle
Office of the Regional Administrator
701 Fifth Avenue, Suite 1600
Seattle, WA 98104
Deputy Consortium Administrator for Seattle/Chicago, John
Hammarlund 206-615-2306
Deputy Regional Administrator, Darryl Means 206-615-2306

I would try complaining to them directly vs. calling Medicare. Sometimes this can work. It often depends.

From what I understand Medicare (DME or durable medical equipment) is split into four jurisdictions.
Jurisdiction A: Connecticut, Delaware, District of Columbia, Maine, Maryland,
Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania,
Rhode Island and Vermont
Jurisdiction B: Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio and Wisconsin
Jurisdiction C: Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi,
New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina,
Tennessee, Texas, U.S. Virgin Islands, Virginia and West Virginia
Jurisdiction D: Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho,
Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota,
Northern Mariana Islands, Oregon, South Dakota, Utah, Washington
and Wyoming
Each jurisdiction has a provider heading it:
Jurisdiction A: Wilfred Mamuya, MD, PhD
wilfred.mamuya@noridian.com
Phone (701) 277-2789 Fax: Not listed
Jurisdiction B: Stacey V. Brennan, MD, FAAFP
stacey.brennan@cgsadmin.com
Phone (615) 782-4662 Fax (615) 660-5997
Jurisdiction C: Robert D. Hoover, Jr., MD, MPH, FACP
robert.hoover@cgsadmin.com
Phone (615) 782-4476 Fax (615) 664-5955
Jurisdiction D: Peter J. Gurk, MD, CPE, CHCQM
peter.gurk@noridian.com
Phone (701) 277-2603 Fax (701) 715-9485
(At least as of 2018)
These are the names of the people that are at the bottom of any letters that are sent out about Medicare and diabetic testing. This information was correct as of April 16, 2018.

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You have to learn to enjoy it.

One of my hobbies is wasting telemarketer time. I used to get mad, maybe say something nasty and hang up like most people do after being forced to stop what they are doing cause the phone is ringing.

Now I answer and say great lets lower my credit card interest rates !! How are you going to do that ? (ask as many questions as I can before they ask for my card number).

Hold on l am in the shop let me walk back to my office and get the card so I can give you the number (more time wasted).

Ok the expriation date is… And the number is 4657-9867-9981-1976

Can you read that back to me ? OK 4657-4867-9981-1976

Did you say 4876 ? yes

I usually score extra points by getting the tele-scammer to curse at me and LOL

I am actually sad those vehicle warranty scammers quit calling.

Does it cover the camshaft, is that a drive train component ? Then what does a camshaft do? What about that yellow light for low fuel, what if that stops working ? What if a wiper blade falls off am I covered ?

$250 a month, ok , let me go back to the office and get my credit card…

Learn to enjoy it.

I won, they stopped calling. Took me off the lists.

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The pharmacists just doing their job.

image

Why those 4 words still get people a free pass I will never understand.

We could probably make some pretty good memes like for twitter with insurance company and pharmacy logos that include people. Just doing my job meme google images found me the above.

I’m not in any way condoning what this pharmacist tried to do to you. I’m just asking…

Forty test strips would last you 16 days at three a day. What are you supposed to do then? Do you go without for the remainder of the 30 days? Do you go back and get another 50 strips? I don’t get what they expect a person to do. You were written a prescription for 30 days. You should get enough for thirty days, not for barely half of it.

Also, I have heard that it’s fairly easy to get around the Medicare three strips a day rule by having your doctor write a letter saying that you need to test more frequently than that and therefore need more strips per day. Is this true or is it false?

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@Cinderfella I think they hope you as a customer are uninformed and unwilling to fight. This is the proverbial squeaky wheel situation. My current PBM is not fond of me for being a giant PITA to their absurd policies. Medicare is no different. If they can save a few nickels or dimes here and there, all that money adds up over the entire user base and the year. Sort of like skimming all the fractional pennies off transactions and aggregating them. They add up fast.

I’m so glad I buy my own test strips. For the record though I’ve never had any problems like these with my prescription coverage. If I need more insurance strips, I ask my doc to prescribe more. I currently have an rx for 10/ day that they fill through mail order whenever I want…but I prefer my own meter over the one my insurance covers so I buy my own. Doesn’t end up being much more expensive really… costs me $45 / month to buy 300 strips with cash for the month ad opposed to $75 for then 90 day supply with my insurance… and I don’t have to argue with anyone about how many I need. Well worth the few extra bucks

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I get 300 strips per month. (I used to get many more, but no longer need so many)
I don’t have to argue with anyone.
They cost me nothing.
They are my favorite strips.

I think I won. :slight_smile:

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Sorry about the delay in responding. I was “out of touch” for a bit. Your information is great as usual. The incident of which I spoke was before I was on Medicare. My insurance had no problem with me getting 100 strips each month. The pharmacy had no problem with it. I had been getting the 100 strips from this pharmacy under my insurance plan for YEARS. It was only this one particular pharmacist that was just a jerk. No other way to say it. She just wanted to exercise power over me. The head pharmacist was off that day and he never had a problem with filling my strips with 100 each month.

What if this were an oral medication and was supplied in bottles of 50 or 100 and the script said to take 3 pills per day? Would she have given me a bottle of 50 and said take nothing for the rest of the month? (Assuming bottles could not be opened.)

This happened several years ago but STILL makes me angry. She was just much too obstinate. She wasn’t following any rules except her own. 100 was OK with the head pharmacist, with the physician, with the insurance company, and the ONLY person or entity objecting was this rude, mean, power hungry, person.

I just found your post about CVS and test strips. I had the same issue this year. CVS never notified me of the policy change, however. After calling several pharmacies, I learned that Walmart will dispense more than 300 strips for a 90 day supply for T!Ds on Medicare. I have gotten my first supply from them; it went smoothly. I have also talked with a Cub food pharmacist who said they will also dispense the number of strips your physician orders. It pays to call various pharmacies in your area. You are fortunate if your Rx plan will cover strips–mine won’t and my Part B supplement doesn’t cover the brand of strips I use. Medicare is way too complicated!!

This is good info. Thanks for posting.

I live in Japan, and just last year the national health insurance decided that we diabetics only get enough test strips each month to test 3-4x/day. I was livid! But my doctor told me to rely heavily on my CGM information. I was skeptical, but it has worked well for me so far. Actually, some days I only test once!