Here’s a link to the FDA website making this announcement.
What do you think various payers such as health insurance companies will do in response to this news? Is it possible or probable that coverage for fingerstick test strips will be limited to 2x/day?
Will this remove the US Medicare impediment for inclusion of CGM systems as a covered benefit?
Happy to hear it’s now “official” as we’ve been using Dexcom readings alone for nearly all treatment decisions for about 2 years now. And I have a sneaking suspicion that my daughter fingersticks once a day (if that often) because her meter reading and Dexcom reading are consistently within 5 mg/dL of each other. So she doesn’t see the point in calibrating other than after starting a new sensor or restarting a current sensor.
I have absolutely no faith in either health insurers or Medicare using this information to benefit PWD. I fully expect them to somehow twist the facts in order to justify depriving PWD of something… I truly hope I’m wrong.
I think the biggest knock-on effect will be indirect. This opens the pathway for the FDA to approve “artificial pancreas” systems that rely on the G5 for the base-data to release single or dual hormones. I also think this was expected. I’m not hopeful that this will change Medicare’s stance on CGMs (which I honestly believe is just about cost, nothing more), and I’m, like Rose, not hopeful that insurance companies won’t use this as an excuse to screw us over.
I can’t see them limiting my strips, since I don’t have a CGM. But I can see them limiting strip reimbursement for those who have a prescribed CGM. Maybe time to look at those newfangled subscription strip models.
I think this is a good but like everyone else, I hope it does not mean a restriction on the test strips.
Stocking up on my strips as we speak…
I want to congratulate the FDA for taking this necessary step that will help PWD going forward. I think that the patient community influenced this timely step.
[quote=“Terry4, post:2, topic:58134, full:true”]
Here’s a link to the FDA website making this announcement.
What do you think various payers such as health insurance companies will do in response to this news? Is it possible or probable that coverage for fingerstick test strips will be limited to 2x/day?[/quote]
Would that be bad? I’m not offering an opinion – this news is a minute old for me, and I’m just digesting it. You raise a good point.
I have a G5. Often I end up using just one strip in a day just to calibrate.
However, that’s my personal experience, and certainly doesn’t dictate the demands diabetes places on you. Given my situation, I don’t have the basis to understand why it would be any more objectionable to be restricted in test strips if I have a CGM. I don’t need them.
I’d love to hear from someone who does have a CGM and still needs to test more than twice a day, routinely.
For many of us while grateful, its pretty much nothing more than “welcome to the party”. As Rose & her daughter, I’ve been dosing based on my G4 then G5 since just a few months after I started using it.
There is no need to make fingerstick checking and CGM use mutually exclusive for payer management. I think a wide majority of CGM use will naturally lead to fewer strips used. For the few that need a blend of CGM and strips, they should enjoy unfettered access to both.
I think the unstated concern is that this will result in greater overall expense (which seems a reasonable first-order assumption). So who’s going to pay for it?
The patient, who else? In the end, it’s always the patient who gets screwed.
I dose off of my G4/G5 most of the time. But I would have a hard time only testing twice a day. I started a new sensor on Sunday. It was OK for the most part but today I had three times when it claimed I was Low. Because I didn’t feel that low, my only recourse was to test. Finally I did the Dexcom recommendation of three tests each ten minutes apart to get the sensor back in line. So I have probably tested ten times today. But there will be many days once this sensor gets established where I will only test 3-4 times a day. My last sensor lasted 22 days and that is not an uncommon performance for me. But I need more than two finger sticks a day to get this to work. But I don’t need to test 12 times a day.
Annual health care costs for me and my wife and 2 children is substantially more than I pay out of pocket each year. This is due predominantly to my diabetes, which with insulin, pumps, CGM sensors, test strips, and everything else all of you are painfully familiar with, is more expensive than my out of pocket each year.
So, that money’s coming out of someone else’s pocket, not mine. (And thank you, by the way, all you other Blue Shield customers).
They have every right to ask, don’t you think, when they’re paying, “do you really need that?”
As a doctor, you know that’s not a silly question. They show up at doctors offices demanding stuff they’ve seen advertised, and have to be talked out of it. Also, people “need” things all the time that, when faced with having to make a real cost/benefit decision about it, are more true to what they actually need.
My question to @Trying was sincere, and asked with only good will. There’s nothing more to read into it than the plain words right there. I personally don’t see any need for more than 2 test strips per day, on average, if someone has a CGM. So if you were to come to me and tell me you need more, so I need to pay higher insurance premiums to cover your (and others with the same judgement) need, I think it completely fair, civil, and moral for me to ask, “why?” – especially when I too have direct experience and don’t see the need…
Hence, wanting to understand someone’s perspective who does feel this is a need for them.
Obviously what a third-party pays for must be limited. Few if any here would willingly purchase insurance that covered funding priests and organized prayer vigils as treatment options, if other insurance is available that doesn’t cover those methods. Further, I expect you’d be ticked off if as part of the Republican healthcare reform reform this is mandated for all plans (sound familiar?).
The point is just to demonstrate that no one with anything serious to contribute to discussing workable solutions to health care provisioning and funding fails to recognize that what can be provided is naturally limited, as resources are limited.
So, once we have recognized this, we are at that point, we’ve established that we’re whores, we’re just negotiating over price
Back to this discussion, who’s gonna pay for it, and if NOT the patient directly, then what’s the case to convince our benefactors that they should pony up?
I’m guessing that the way this will play out will be the default “baseline” policy that insurers will adopt is 75 strips/month (note, this is a 50 and a 25 count bottle) for anyone with a CGM.
It will be an extra PITA for people like Laddie who will still be able to get more approved, but will have to go through a process justifying it, which in my experience can be anything from trivial (have your doctor simply send them a letter requiring it) to major root-canal.
All swords have two sides, this one may cut 12 ways before t is done. Like all D everywhere, I know this too shall be absorbed.
however in the short run, let’s hope this clears a path for CMS to approve the CGM for payment.
“I personally don’t see any need for more than 2 test strips per day, on average, if someone has a CGM. So if you were to come to me and tell me you need more, so I need to pay higher insurance premiums to cover your (and others with the same judgement) need, I think it completely fair, civil, and moral for me to ask, “why?” – especially when I too have direct experience and don’t see the need…”
@Dave26, let’s expand your view a bit further. What if I don’t want to pay higher premiums for someone who uses more insulin when they could follow extreme low carb & reduce their insulin use? This is the problem I see with your view. CGM does not work the same for everyone.
While this is a social media peer support group based on providing mutual support, I will only look out for me. Too bad for you addled-brained bleeding hearts that might worry about the wider needs beyond what’s good for my, me, and mine! /snark