Can anyone provide information on what to do if my preferred test strips are now “excluded” from coverage by my insurance company? Express scripts has notified me that starting jan 1 they will not cover contour test strips.
This would not be a big deal if the contour meter did not talk to my insulin pump. Having the connectivity is a huge convenience, as is the ability to upload to the website.
Since going on the pump 3 months ago, I have lost 15 pounds, and my a1c went from 8.9(which was probably inaccurate due to the frequent lows factored into that average -a low of 30 was not uncommon before the pump and neither was a high more than 600) to 7.2 (with barely any lows skewing the number). To say the least, life changing… I owe this partially to the ease of taking insulin by having a meter that talks to the pump…
Has anyone gone through similar situations with their insurance company? Any advice for me on how to work through the red tape?
Hi Brieanna- Glad to see that your A1c has improved so much. I can't tell you what to do, but I have Express Scripts and the Contour Next. I have not received notice from Express Scripts, but that might be just a difference in the insurance plans. You could try to contact the person at work who is responsible for insurance problems. I found Express Scripts made a lot of mistakes when I tried to start mail delivery of prescriptions as my insurance plan required. It could actually be a mistake. It doesn't hurt to ask.
http://freepdfhosting.com/81b6e1e750.pdf This link is to the list of 48 products ExpressScripts is removing from their formulary. The president of ExpressScripts announced it last week. As you will see Novolog has also been removed.
You will need to get your doctor to do an override. It may work...it may get you the strips for the same price as the One Touch strips which are the only ones now on ExpressScripts formulary or they may charge you more. You won't know until you try. Here again is the link to the 48 products ExpressScripts has removed from the formulary. http://freepdfhosting.com/81b6e1e750.pdf
CRAZY! Is it a little strange that they are removing every other type of meter/strip but one touch??
I will definitely be contacting my doctor to see if they can help. The customer service rep at express script was ridiculously un-helpful, and confusing. I will be refilling every chance before jan whether I used all my strips or not.
I see on the list posted for the changes by ExpressScripts that they will cover One Touch. I suggest you ask your doc to write an rx for a new meter and associated test strips but check with your benefits rep at work to see if you should call the insurance co. first to make sure you can get another tester, etc. before submitting the new script to ExpressScripts. I used the One Touch for a number of years and have had a pump now for about 3 yrs. The one touch product also "talks" to your pump and can be downloaded to the Medtronic site. Best of luck to you!
Actually, Medtronic stopped using OneTouch with pumps...Bayer ContourNext is the meter they now use. Older pumps can still use OneTouch, but they have encouraged everyone to switch to Bayer.
I see. I did have to switch from the One Touch meter and strips to the Bayer ContourNext for a few months and then we switched again a couple months ago to the NovaMax. For me the latest change was an insurance initiated one...not something from Medtronic. Guess it depends also on what products your employer has chosen to cover too in the contract they negotiated with the insurance provider. I know that is looked at on an annual basis by most employers since I worked many years in Human Resources Administration.
I also just found out that none of my current blood test strips will be covered anymore by Express Scripts. So I went to American Diabetes Wholesale and a box of 100 Bayer Contour Next strips are $50.48, so close to $0.50 per strip - not bad if I have to cover them myself. No reason to use Express Scripts and pay full price - what a rip-off!!!
Can't you find another provider approved by your insurance carrier? Many companies and Medicare will now cover contour next supplies if purchased from CVS or Walgreens.
I'm not sure about this. All of my prescription drugs go through Express Scripts whether I go the mail order route or go to any of the retail pharmacies (Krogers, CVS, Walgreens, etc...)
But I will definitely see what my local pharmacy can do for me. The last time I was at Kroger's, the off-the-shelf price for the Contour Next prices were about $0.50 each so the same as American Diabetes Wholesale.
I'm having the same issue - I use Bayer Contour and Express Scripts. I'm not sure if this will help, but before they came out with the Contour meter, Minimed used a meter called a Nova Max Link (it communicates with the pump the same way the Contour does) and I got the strips through Express Scripts. You may be able to get one of these meters (you may even be able to contact Minimed to get one) and then move to the other strips. The down side of this meter is it's much larger than the Contour but if the strips are covered it would be worth it. I have found that the readings on both machines are pretty close. Hope it helps!
Since the strips and pump go together you should be able to get an insurance preauthorization for the strips. You may have a higher copay as your insurance contract changes but Bayer does have a copay assistance card that can be used at a retail pharmacy.
NovaMax meter is what I have been using. Agree it is larger than the Bayer Contour but not very much and in fact, I prefer how it fits with the container of test tapes in the case they provided. See my post last night.
I had a similar situation with my insurance company. It took many phone calls up the food chain and me constantly reminding them that I pay their salary because my hard earned $ is taken out of my paychek for coverage. I also had to remind them that the pump that I use for it to function properly I need to use that type of test strip. Lest they forget that the pump also keeps me alive. I was able to get the rx covered for 1year. Hope this helps.
I have spoken to contour and Medtronic customer care. Contour does not seem to care, the rep didnt seem to understand what i was saying, in the end just told me to buy from the warehouse suppliers… at 0.50 per strip that is still $120 per month on test strips…
Medtronic was more sympathetic, but no hint that they plan to go back to one touch meters that work with the pump.
You can use any BG meter to get a reading, and then manually enter it. It doesn't have to come from a Bayer Contour meter.
My insurance company has also made One Touch as the preferred brand, however they do cover Bayer as long as there is a letter from Dr confirming it is needed for use with MM insulin pump. But it is a convenience factor, and improves data correctness, so it's up to the Dr if they are willing to 'justify' it.
This is confusing. I just got a new pump 530G and another new meter, Contour Next. Yesterday my doctor wrote a script for 1 year for 700 for a 3 mos. supply. So I am wondering why they would accept a new prescription for these test strips since they just added them to the formulary. I had been buying them from Medtronic before because they didn't carry them. The other disturbing thing is Novolog is being removed? Who uses Humalin anyways?
