Dexcom G6, Medicare, and Test Strips

I learned today that Medicare will no longer cover ANY blood glucose testing supplies if a person is on the Dexcom G6. Now I have to decide if staying on the G6 is worth it.

1 Like

That really is not reasonable I think. However I don’t use many strips now that I’m on g6. So the cost for them is very small.

1 Like

I know that the cost is probably something I could handle, but aren’t you just tired of non-medical people telling you what is or is not “necessary” to control your diabetes? Sigh. And Dexcom is no help with their “no finger-sticks or calibration necessary” marketing. If that were TRUE, then why is there a calibration setting on the G6? And why does the instruction manual state in no less than a dozen places to “test your blood” if the settings seem wrong? And what should we all do if we need to eat something during the 2-hour warm-up time when no settings are available? Should we base an insulin dosage on a WAG of what our glucose levels might be? I really don’t expect anyone to answer those questions because there are no reasonable answers. I just am frustrated with insurance companies and pharmacies and manufacturers who care only for profits and nothing about our health. Thanks for letting me vent. I am going to go for a nice, healthy walk. At least fresh air and sunshine still are free.

4 Likes

There’s no question there for me. I think CGM is the most critical tool to excellent management.

It totally sucks that Medicare won’t pay for any strips, too. But I only test 10-15 times a month now, most of those tests being at the end of a sensor’s life when the accuracy starts getting wonky. If you’re choosing one over the other, paying for 10-15 strips out of pocket would be my clear choice.

2 Likes

I think some people with Medicare Advantage plans may be able to get as pharmacy/drug benefit, instead of dme.

1 Like

I get strips if I want them, however I use maybe 5 a month now instead of 60-90 before cgm.
I’m on private insurance so it’s very different.

I am not on Medicare but I knew this was going to happen. I worried about all the talk about systems that didn’t need to be calibrated. And I knew insurance companies would use it as a reason to discontinue coverage.
But as we all know, there might be times you need to test. System is not connecting, system seems to be off, you are in warmup and need to drive. All kinds of reasons. Sure I don’t test much anymore but once in awhile when I am in warmup mode and I want to eat, I need to test.
I don’t have to fight the insurance fight yet as I have a stockpile. But I know I will have to fight the insurance battles to get that one bottle of strips covered.
Please don’t give up! I hope you have a good doctor willing to help you fight the fight!

1 Like

I called my doctor’s office and told them that Medicare would not cover the Contour Next One strips for which she wrote the prescription, and the answer I got on a message left for me from the Med Tech who called was, “Check with your insurance company to see what strips they will cover, and she (the Endo) will write a prescription for them.” Even the doctor does not comprehend that if Medicare will not cover test strips, it does not matter WHAT she prescribes. If Medicare won’t cover strips, my supplementary insurance will not cover them either. I am just out of luck. If I want test strips, I pay for them myself. I thankfully can afford a few hundred dollars a year to do that, but the whole idea really irritates me!

3 Likes

I get it. It is not that the G6 is so accurate. On the other side, Walmart brand test strips were very reliable for me when I used them. They are much cheaper. I was told by an Abbott rep when I using name brand Precision test strips that the off brand Precision was the same product bought from them to sell under off brand name.

According to this .gov link, the provider must accept assignment. Maybe more providers are deciding to not accept for bg strips.

https://www.medicare.gov/coverage/blood-sugar-test-strips

Medicare will only cover your DME if your doctors and DME suppliers are enrolled in Medicare. Doctors and suppliers have to meet strict standards to enroll and stay enrolled in Medicare. If your doctors or suppliers aren’t enrolled, Medicare won’t pay the claims submitted by them.

Make sure your doctors and DME suppliers are enrolled in Medicare. It’s important to ask your suppliers if they participate in Medicare before you get DME. If suppliers are participating suppliers, they must accept assignment (which means, they can charge you only the coinsurance and Part B deductible for the Medicare‑approved amount). If suppliers aren’t participating and don’t accept assignment, there’s no limit on the amount they can charge you. Medicare won’t pay claims for doctors or suppliers who aren’t enrolled in Medicare.

Yes, we read this online, and that was our argument with the drugstore; however, since Dexcom markets the G6 as not needing calibration and all of the ads feature their “no finger sticks necessary” claim, the drugstores and Medicare now claim that the blood glucose testing supplies are no longer “medically necessary.” We all wish that claim were really true!

1 Like

Does the drug store get a reject when processing as pharmacy?
Can they choose to process as pharmacy, assuming your formulary lists it, rather than dme?

(I just checked my pharma formulary and see they added freestyle strips. Will try a script from dr and see what happens. Contour Next is my preference,and pay oop, but freestyle is almost as accurate. I am not on medicare.)

Our employer recently made changes to our health insurance. It wasn’t presented as a change in the plan to the employees, so … we weren’t aware. No excuse. We should have read the 30-page plan book in full. I’m not being facetious in this; we were seriously at fault for not reading it.

The plan change was … all of our maintenance prescriptions need to be for 90 days, which required all new prescriptions, as ours are for 30 days.

Not having enough time to get that accomplished and we couldn’t get an override for a month quick enough, we went another route, cash pay.

With cash pay, at Sam’s Club, with our plus membership, we actually paid less than if we were to fill a 30 or 90 day prescription. Shocked the dickens out of us and we plan to continue to pay cash, filling only a 30 day supply.

The only pitfall is … I use a copay assist card for my insulin, but I can’t pay cash and use the copay assist card; it has to be used with commercial insurance. So, I called and the endo sent in a prescription for a 90 day supply and that was that.

I don’t need any test strips; but at some point during this calendar year, with this current insurance plan in place, I will see what the cash price, less plus member rate, is for a vial of Freestyle test strips.

Last year my plan did the opposite, now all pharmacy must be 30 days. May be able to still do 90 day mail order for some, but I did not switch. Pharmacy is just 2 miles away and has drive through pick-up.

1 Like

It is something how each plan has something a bit different. How for one a 30-day supply is more (or less) the cost of a 90-day supply. We were told the 90-day supply would only cost us two months, rather than three months. We still didn’t want all those larger bottles. Sometimes I think we could use a room just for all of our medical gear and medicines!

1 Like

Valid issue. My own experience with Dexcom G6 is I need to calibrate it a lot during the first day of a new sensor and sometimes later. Overall, though, I use far fewer test strips than I did with G5.

I have what would be considered an old meter – OneTouch Ultra2. Turns out GenUltimate sells strips for that meter – on Amazon in the US, they cost 36 cents per strip and I am willing to pay that myself. When i first discovered this brand, I did fairly extensive comparisons of genuine OneTouchUltra2 strips and GenUltimate strips. I concluded they both have about the same variation and are equally accurate. I noticed on Amazon some customers had accuracy problems and I very strongly suspect they failed to tell their meter the GenUltimate Code number (calibration number) since OneTouch long ago stopped changing their code numbers on each batch and most users simply forgot about that step. So while I am disappointed my insurance will not cover the cost of a few test strips, at least they only cost me 36 cents per test and I really don’t use them all that much.

Like many of the other replies, since starting with Dexcom G6, I do not test as much. In fact I had so many test strips from purchasing them last year from Amazon that the last of my supply will expire this summer. My test strips were not covered by my private insurance and they are not covered by Medicare that I have now. I would strongly discourage a Medicare Advantage plan for a diabetic or someone with a lot of chronic problems because often those plans have limited providers and require you to jump through lots of hoops to get what you need. I recommend finding the strips you like and getting them through Amazon. Jane

3 Likes

I am on Medicare and a supplemental. The supplemental picks up any costs Medicare charges as long as it’s covered under Medicare. When I talked to Medicare they said test strips are not needed to use with a G6 and they will not cover them. I don’t think it matters how your doctor writes the prescription, Medicare’s red tape says test strips are no longer needed with a G6. I wonder at some point if a doctor will figure out a way of writing it to get around it, if yours does let everyone know!!

I believe it was probably marketed to Medicare as you don’t need test strips anymore, plus they used to be supplied with the G5 and Dexcom is getting out of the supply side of things to individuals. I’m sure the decision to not provide test strips was also a cost saving factor for them.

It’s nuts because they constantly repeat in their manual and training videos “when in doubt, get your meter out”. When you call in a bad one, you have to know it’s off and by how much, so they do acknowledge they have “off” ones, you can calibrate it because it can be off, and it can be off for quite a while and you only know how long because you test with test strips. I had one off 80 points 12 hours after it started, I dosed for it and then realized it was a new sensor from the night before and then tested and had to eat because I dosed without checking first. Also several people have been sensorless with delays in shipments or replacements. It takes weeks for me to get a replacement…I have a ton of back up supply but many don’t.

I don’t use strips for days, I can go through a lot of strips though that first 24 hours. it’s mostly when I am starting one or I feel one is off, I had a huge supply of One Touch strips left over from pre CGM days, (expired they worked fine btw, I compared it to my Contour several times) But I am now buying test strips and it’s annoying that I have to. With Medicare now I don’t pay anything for my insulin which used to be $100 every 3 months. So I suppose I break even.

I just think it’s so nuts when what our blood sugars are at is so important to us for dosing, eating, driving, sleeping, exercise, and gee to stay alive, that the decision for no strips needed is fundamentally wrong.

3 Likes

What you eloquently wrote is exactly what I was trying to say. Medicare will not pay their share of test strips, and in not doing so, they put people’s lives in danger. One key point that irritates me is that the government (Medicare) has once again made a decision on our healthcare that contradicts what my doctor knows is wrong (otherwise she would not have written a prescription for me!), and I have to live by the government’s choice. Don’t get me wrong. I am not anti-government, but I am against ANY insurance company that, to try to save money, dictates what is “best” for my health. And then they walk away with record profits.

Personally, I thank God that I do have the financial ability to pay for strips, but like you, I do test at least once or twice a day because my G6 numbers are often “off” from my actual blood sugar. My concern is that many retirees do not have “extra” money to pay for strips as they struggle to pay for their share of the CGM supplies. We all know that poor control may lead to other health issues which, in the end, will probably just cost Medicare even more money. Why can’t the Medicare people understand that?

2 Likes

I think that Medicare rule is super silly BUT certainly not worth giving up the G6 for. I rarely if ever test anymore because the G6 doesn’t need calibrations. I have leftover strips because I was testing my bg 6x a day to qualify for the Dexcom. I assume since using the Dexcom, you are testing much less often. Just buy a very inexpensive box of test strips with reader included at your pharmacy or Walmart. Dexcom does send sensors quickly if your sensor doesn’t last the full 10 days or something happens to the transmitter.

Dexcom is my near complete liberation from having to use test strips. Amazon and ExpressMed have some of the best prices for the more expensive strips. No prescription or LMN required. Buying strips from ExpressMed was less expensive than filling it with prescription with LMN from my endo. I used my Dexcom alongside my Medtronic CGM, which required calibration every 12 hours. Over the 10 day span the Dexcom was every bit as accurate as the Medtronic. I did find the best places on my body for sensor placement and start up procedures so my Dexcom lasts 10 days and stays accurate.

Like Nick Jonas says, we’re sending rovers to Mars but PWD are still pricking fingers for a bg test? I’ve been doing finger sticks since the early ‘80s. I’m soooooo done with that crap.