Good Morning Group:
A quick question…
I have a script for glucose test strips at my local pharmacy, that I haven’t picked up yet. My concern is that Medicare won’t approve/pay for the strips, now that I’m on a CGM.
Definitely, not looking forward to a whopping out-of-pocket bill in the new year.
Has anyone else experienced this situation ?.
From what I have read on this subject lately on this forum there seems to be a wide variety of coverage/payment results depending on your particular situation. Part B vs Part D, Pumper vs MDI, location. how script was written, how script was put through to medicare by pharmacy etc.
I am on Medicare and and am still on the Dexcom G5 system as Dexcom has not yet changed me over to the G6 so I get up to 150 test strips per month, depending on usage, directly from Dexcom as part of the monthly Medicare Dexcom Direct subscription package. My Dexcom package is 80% covered by Part B medicare and the 20% balance by my supplement coverage.
I would think your easiest starting point is to call the pharmacy and ask them the cost of your prescription and then go from there. You can use the search bar at the top of this page to find out how other Medicare patients have been able to optimize the lowest possible payments for strips at the pharmacy.
G5: you should have no problem
G6: depends on who you talk to but I think the deal is that no longer will Dexcom supply strips, but a doctor’s Rx sent to a local pharmacy should get you the strips (Part B and with a supplemental plan, the cost should be zero). Don’t get sucked into paying for them because the pharmacy processes them under the drug plan!
Dave, do you know if that is for pumpers only or also MDI? I have read conflicting information on that one but will find out for sure as soon as Dexcom forces me onto the G6. I am MDI
Part B coverage for insulin relates to pumpers only. Strips are covered by Part B regardless if one pumps or not. One doesn’t even have to use insulin, to get coverage under Medicare Part B, for test strips
Awesome - Many thanks and have a wonderful holiday!!!
I think that’s Dave’s assessment is spot on.
Although it is dated August, 2018, here is the best Medicare document that I have found that talks about what is covered under Part B and what is covered under Part D for us Medicare-eligible folks. It also has pretty specific details as to what a prescription needs to say.
Here is the link:
Finally, it seems as if not all pharmacies are equally adept at processing things under Part B. My recommendation would be to speak directly to the pharmacist before sending a Part B prescription to them … but even that may not guarantee trouble-free processing.
Good luck,
John
Understatement! 
First we tried Safeway for our strips. They charged us over $300, combined, for our 3-month supplies. I knew they were wrong to charge us, so I fought the charges. It took at least 3 months for them to see the error of their ways and I got a full refund.
Next up, Walgreens. They seem to have never done a Part B Rx for insulin, given how totally clueless they were. It took both of us two weeks or more, many phone calls, and time at the store, to get them to process the insulin without charging us. Even the second time my wife’s insulin Rx was due for pickup, it took days for them to once again figure out how to process it. I don’t know what gives with pharmacies these days. No one at any of 3 pharmacies we have used know what they are doing with regards to part B Rx’s. Walgreens also kept trying to charge us for strips.