Dexcom G6, Medicare, and Test Strips

Type 1 and LADA
21

Could you get test strips filled from your Part D insurer?

22

Nope. Has to be Part B. I am just SO tired of trying to fight Medicare, and that is exactly what they want. They want us all to just shut up and give up, and that is what I will do. I can pay for my test strips, and that is what I will do. I sincerely wish I could win the lottery so I could tell Medicare to go shove it. Then I could do what I want with my healthcare and not have to worry about expenses or bills. Sadly, that will not help the hundreds of thousands of others who are in the same boat. We all just must do the best that we can.

23

I agree with everyone that it is somewhat non-sensical the CMS will not cover test strips if we have CGM.

Why did that come about?

Several years ago, CGM was defined as “adjunctive” (I.e. an “add-on) technology and, as a result, Medicare wouldn’t cover it at all.

So, Dexcom work very hard to improve the accuracy so that it was defined as a “therapeutic” technology so that insulin dosing could be based on your G6 readings, rather than on a finger stick. And that, in turn, opened the door to Basal-IQ and Control-IQ. But, almost by definition, to be good enough to be “therapeutic”, you can’t say “But I need finger sticks to calibrate my G6”. Even though we know, at some level, that is true … if you say that out loud, the G6 is no longer a “therapeutic” device.

So we each can have an opinion on the following question:

Would you rather have test strips covered, but no coverage of G6 or the ability to use closed loop systems based on G6 readings … or would you rather pay for test strips OOP and keep coverage of your G6 including B-IQ and C-IQ?

You can only choose one. You can’t have both …

Me? I vote for my “therapeutic” G6 and C-IQ without regrets.

Stay safe!

John

24

Thanks for your explanation. This is the first time that Medicare not covering test strips almost makes sense. Sadly, I am one of those people who cannot trust the G6 readings. During the day, I will have one reading that is only 10 off from a blood test, but that same day I will have a later reading that may be 25 - 30 off from a test. I am VERY sensitive to insulin, so dosing just off of the G6 could be dangerous for someone like me. I like the G6 to give me warning of when I am heading up or down, and I appreciate it during walks when I can see how rapidly I am trending down, but I cannot trust it for dosing. Stay safe and well.