FreeStyle Mail Order Fiasco

Diabetes Technology Insulin Pumps
1

In trying to get Caremark to cover my prescription for the FreeStyle test strips, I have once again been told that I have to use One Touch as the preferred brand.

In the process of dealing with Caremark, my employer, Abbott Labs, and CVS Pharmacy, I learned that under a new policy, MEDICARE WILL NO LONGER COVER FREESTYLE TEST STRIPS THROUGH MAIL ORDER. While I am still too young for Medicare, the pharmacy told me that if Medicare will not cover them, chances are no insurance policy will cover them through mail-order either. I further learned that Caremark refuses to cover anything but One Touch because they are the company that Caremark has made a deal with. (Money talks.)

Discussions with FreeStyle led me to see if I could change from mail order back to my local pharmacy. The pharmacy told me that since FreeStyle was no longer covered through mail-order, chances are they would not be covered in-store either. On top of that, when I asked about buying another FreeStyle meter, CVS told me that they were only carrying the Lite meters. Buying a Lite meter, of course, would mean getting a second prescription for the Lite strips. Because CVS only carries the Lite meters, I suspect that getting the regular FreeStyle strips that the PDM uses will become even more difficult.

The FreeStyle strips cost $147.00 for 100 if I have to buy them outright. I use approximately 210 a month, or over $3700 worth of strips a year. At that rate, the strips will cost more than the Pods!

All of these headaches could be avoided if Insulet would just change from Abbott to One Touch. One Touch is so powerful that they have made deals with all of the major insurance companies as the preferred brand, and I am really disappointed that the new PDM still uses FreeStyle. Does anyone know why OmniPod chose and remains with FreeStyle?

Can I use the One Touch and manually enter the results? Sure, but then why use the OmniPod system? I am to the point where I may need to go back to MDI, and I know that my control will not be as good.

Has anyone else had similar problems getting FreeStyle strips? My insurance is UMR, so they deem the strips prescription "drugs" rather than durable medical supplies. Any suggestions?

2

Sounds like it's already in the works, but I wouldn't hold your breath:
http://investor.insulet.com/releasedetail.cfm?releaseid=649024

Good luck with navigating the prescriptions. In my experience, the mail order folks will tell you anything to stick with them. Local pharmacy all the way!

3

Since that article was written in 2012 before the release of the new PDM and smaller Pods, I suspect that the deal went south and that we will not see the One Touch anytime soon. Like everything with Insulet, I have long ago decided to not deprive myself of oxygen waiting for something to happen. Don't get me wrong... I love the OmniPod and all of the freedom and control I get from the system. Not being able to get the materials I need to run the PDM, however, is extremely frustrating.

I also agree that changing back to my local pharmacy may be the way to go. At least then I can deal with a real, live person.

4

Sorry you are having such a hard time. We’ve had no issue getting the freestyle test strips through mail order. We get them from Express Scripts / Medco and they are covered by insurance. I have also seen the strips at CVS. It’s true you can’t buy the meters anymore but I have two from Insulet and have gotten a few other extra ones from the local Abbott rep. I know people who have also bought meters off ebay. We love the freestyle strips because they take so little blood for my three year old. I’m actually a bit scared that they will stop using them.

5

I use a freestyle lite for part of the month and yes, enter the results in manually. I have Oxford and am having the same issue. apparently if I get my doc to write a prior authorization, I can get the freestyle for a year. they’re also trying to get me to switch from novolog to humalog, which I don’t want to do. very frustrating but check to see if a PA from your doc will help

6

1) I am fulfilled by Caremark too and they WILL cover Freestyle strips IF you are on the Omnipod. Somehow you may not be getting to the right people in Caremark. I needed a letter
from my doctor to the authorization department saying I was on the Omnipod. I then got a letter from Caremark saying the Freestyle strips were authorized and they filled the prescription

2) Abbott is running TV ads now saying that they ARE covered by Medicare under the new plan

7

My endo sent in TWO letters of medical necessity (which is the same as the prior authorization) last time, and just faxed in another one for this order. Caremark apparently wants this type of letter. When I had Medco, everything was covered. My employer promised when they switched to Caremark that nothing would change... but, of course, it has. This is all so frustrating partly because those who are making decisions do not understand the system, and partly because I do not understand what right an insurance or mail-order company has to determine what medical devices I need or what insulin you should take to stay alive!

8

My insurance (Blue Cross Blue Shield) has a $100 co-pay. I use FreeStyle's secondary coverage to make them only $15. Make sure you take advantage of that. If nothing else, they may be able to reduce the retail cost.

Also, don't worry about the "Lite" versions. They work just fine. Though Insulet is not allowed to say they do. It's what I use.

9

I've used both Novolog and Humalog over the years, switching to whatever gets covered best by whatever insurance I'm on at the time. I can't tell a difference. But, the first month or two after the switch things might be a little off. Once you're body's used to the change, it's not any different.

10

SherryAnn... I had much the same experience...I was on Medco too and was switched to Caremark in 2012....it has been a PITA.

11

Thanks for the response. My endo actually sent TWO letters to their authorization department last time, but apparently since my employer gave up and just sent in a one-time approval, nothing got into my file. This time, also, my endo just faxed in a letter to Caremark, but I was told that they would take at least 30 days to get back to me. I am afraid that if I wait, nothing will be done.

As for the Medicare issue, my husband talked a woman in Abbott Industry's FreeStyle Promise Program (of which I am a member), and she said just this morning that FreeStyle was not approved for mail-order delivery. I hope that the ads are correct and that she is wrong. At this point, I am not sure who to believe. Sometimes this "information age" provides too much information, and when it is contradictory, it all just becomes confusing.

12

If the Lite works and that is all that will be available, why doesn't Insulet just say so? My endo is a stickler, so if the device calls for FreeStyle (regular), that is what she will write the prescription for. I would hate to have to ask Caremark to fill a second prescription for the strips. They don't even want to fill the first one!

13

I have a worse (or equally bad) problem now.... I tried to refill my pods with Caremark and they are saying they can't get any from their supplier anymore!

Yet my insurance says I have to get the pods through Caremark!

Trying to get this sorted out now.... have called Insulet and seeing if they can help.

I HATE CAREMARK!

14

I have had Caremark in the past with my husband's old insurance, and they were great. I guess a lot depends on which "plan" your employer chooses to use. Once my husband retired, we had to go on my Medco/ then Caremark plan, and they are not so good this time.

I get my Pods through EdgePark and they told me the last time I ordered that they, too, could not get any more Pods from their supplier. They sent me two boxes of the old Pods and told me that when those ran out, THEY would switch me to the new Pods. I did not know they could do that, so I foresee another possible problem in the near future. I hope they are correct because I have not gotten the magic email from Insulet saying that I would be switched over in September.

Please let me know what happens with your Pod order.

15

The lite strips work. It is all I have ever had to use with the PDM, but I have had issues with insurance claiming that one-touch was the only one they would cover, which is the most expensive over the counter... anyway, just get the freestyle light, they work, the PDM will tell you which type of strip you are using, if light, it recognizes it as lite, if regular it says so on the pdm when it tests the blood.

16

I have CareFirst BCBS of MD and they just made a decision on June 17th that they will only cover prescriptions for One Touch Ultra strips. Nothing else. Fortunately for me, with the pod mine are billed under DME. Otherwise, I'd be up a creek without a paddle (or up a creek with another meter?). Either way, I think it is completely unfair for insurance companies to change their rules after the enrollment period has ended and we are locked in for the next 12 months! I hope you are able to work it out and get it resolved quickly :)

17

I called Insulet too today and they are going to see if they can supply me directly under my insurance plan. We'll see... I'm a little worried about this supply problem. It seems like there is a chance we could be squeezed between not enough of the old pods remaining and not enough production on the new pods. I hope not.

I really do not want to go off the pod for any length of time.

18

I know that you can purchase Freestyle and Freestyle lite from Amazon for $25 (ish) for 50 or $50 (ish) for 100. You don't need a Rx. I am on Medicare and an Advantage plan which even picks up my co-pay, regular Medicare requires a 20% co-pay.There are new regulations requiring Mail order sources to be on an 'approved provider' list and this may be the problem as they too, have preferred suppliers. My provider is OneSource and once my Endo sent in Rx I am getting the Freestyle even though my Hubby has to use whatever weird meter they offer.

19

sorry sherry Ann, sounds like a pain! Scott, I definitely noticed a difference between the humalog and novolog - it’s why I switched!! here’s to hoping the PA works, because that stuff does NOT work for me!

20

I’ve been through the same thing and just gave up on using the OmniPod as a meter. I just carry a little OneTouch UltraMini to do BG checks. The added hassle is better than a larger monetary outlay. I like the OmniPod enough as an insulin delivery device that I just use it for that purpose.