Greetings, everyone. For a couple of weeks now, I’ve been talking with Medtronic (my pump supplier) and my doctor’s office, to no avail. Medtronic was in the process of getting my auto order ready when they suddenly had trouble getting the documentation that Medicare requires. They needed office notes, proof of my last visit, and a written order, all signed. Every time I talked with them I got a different story of what they needed. Last week I drove to my doctor’s office and presented my problem to the front clerk. She found my office notes and faxed them over. At that time that was the requirement they were missing. Yesterday I was told by Medtronic they had received the notes but needed a doctor’s order and a signature on all three documents. Meanwhile, my supply dwindles and I have no backup plan. Panic is starting to set in. Have any of you ever encountered a similar problem? When I changed my set today, I added about a third more insulin to extend my wearing time. This is the first time in many years that I’ve ever had a problem getting supplies.
you’re not the only one with medtronic woes. i have private insurance but Medtronic’s having trouble getting guardian 4 sensors for my cgm. so i have been sweating bullets and was down to my last sensor. phone calls didn’t get any action and at one point they claimed my insurance needed to give their approval before they could send my order (which, by the way, is on auto order so doesn’t need prior approval). what it came down to is that they didn’t have the sensors to send out. scary. i love my new 780G and didn’t want to have to go backwards by trying to hook up a guardian 3 to it.
i feel your pain, i hope they come through with your order…
That’s a tough situation and I think you’ve taken reasonable steps to communicate with Medtronic and your doctor’s office.
Do you have a basal insulin in the fridge that you could use if your pump supplies run out? I know that’s a hassle but you should have an alternate method to deliver insulin. In the case of a natural disaster you really need this option covered.
Several years back, I went off of my pump and went MDI for 90 days. That was a good exercise and I’m overdue to do it again. I get an Rx filled once per year for a minimum amount of my backup basal insulin.
I hear you about the unnecessarily complicated supply process. You’re thrown in with the supplier, doctor’s office, and sometimes an insurance company. The finger-pointing can go round and round.
What I have done for myself is build up at least six month’s of supplies such that logistical failures like this do not stress me out. “Just in time” supplies is not viable to me. Build up a “comfort bump” of supplies to insulate yourself and your safety.
Also get some basal insulin on hand and know how to dose with it. I wish you luck. It’s not easy. Try to make some changes so that situation does not repeat itself.
I wish I could build up a reserve for instances like this but Medicare won’t allow shipment until only a couple sets are left. At my appointment with my doctor next month, I’ll ask him to write a prescription for a basal insulin. That way I would feel a little safer. Thank you for your suggestions.
Wow! Down to your last sensor is pretty stressful. My supplies are also on autoship but I think Medtronic has to get approval from Medicare for each shipment. My pump is so old that it has been discontinued so I suppose it could be a supply issue on their end, which is even worse than the other scenario. I’m going to put in another call to my doctor’s office today. It doesn’t hurt to keep reminding them. My pump is about two years out of warranty and I’m thinking about switching to Tandem, which would pair up with my new Dexcom G7 CGM.
I know that most doctors are sympathetic to this situation and would happily write a prescription to change infusion sites every 48 instead of 72 hours. Every doctor I’ve seen in my 40 years of diabetes was happy to slightly over-prescribe the quantity of insulin so that I never ran my supply too low.
If you’re not ethically comfortable with that, perhaps you could invest in acquiring one box of the infusion sets that you pay for out of pocket. It would then give you the peace of mind for this circumstance.
Recently I did get my doctor to add one additional vial to my insulin prescription order, since there had been a delay in my local pharmacy getting my prescription filled, but Doctor said the same, that Medicare would ask how many units I am using per day and then dispense quantity related to that number. Sure enough, they filled the original order, without the additional vial, without so much as an inquiry as to how much I use. Maybe four vials every 90 days seems excessive to them. I wasn’t aware that I could specify the frequency of infusion site changes by a doctor’s prescription. I thought that was determined by the pump manufacturer. I would have no problems with that ethically since it is all being used by myself and is so critical to run short. It’s probably a good idea for me to just buy a couple of boxes out of pocket, just like I’ll have to do with my glucometer test strips. My insurance plan will only pay for a CGM or strips, not both. It’s a shame, with high monthly premiums and yearly deductibles, that we still have to pay for some supplies ourselves.
I’m not sure what transpired with your insulin order. Over the years I’ve found that the pharmacy and Medicare expect to see a doctor’s order that specifies X units per day.
Let’s say, for example, that you and your doctor agree that 4 vials of insulin is what you need for a 90-day supply. 10mL insulin vials contain 1000 units. Four vials contain 4000 units. 4000 units/90 days = 44.4 units per day.
Rounding up a little, your doctor could write, “Use 45 units of insulin per day via an insulin pump.” This order should get you four vials of insulin.
Is your doctor doing this by himself/herself or does s/he have some medical assistants that deal with this? Is your doctor an endocrinologist or a general practitioner?
The infusion sets require a doctor’s order. S/he decides how often you should change them, not the pump manufacturer. The manufacturer specifies not to use more than 72 hours.
If the doctor orders you to change your infusion set every 48 hours, that means the supplier must send 45 infusion sets for 90 days. You might even get 50 since the supplier often won’t break a box of 10.
I agree, insurance should cover a minimum test strip supply. They’re needed for the accurate operation of the CGM. I gave up that fight and just buy them on Amazon
Thank you for the information! My doctor is an endocrinologist and puts the orders into the computer himself. I see now how I can increase the quantity of my prescriptions a little. My doctor has always written generalized orders, i.e. on insulin orders, "Use with pump, 10mL vials X4 for a 90 day supply. I have never seen his orders for pump supplies, such as infusion sets and reservoirs. When Medicare calls before the shipment is coming due, they always ask how often I change them.
I am curious about this call. Medicare itself rarely, if ever, calls beneficiaries. I do get this question in a phone call, for example, from Medtronic staff for every shipment that they make to me. They are also in contact with my doctor’s office regarding my habits that affect supply usage.
This is when I hear the question about how often I change my infusion sets. I’m assuming that matching up my answers with their record of my doctor’s notes is what is happening. They do this to ensure they get paid and not run afoul of any Medicare regulations.
Again, it’s important that your doctor actually specifies that you change infusion sets “every x number of hours or days,” and avoid the x number of infusion sets for 90 days language.
I know this level of detail seems picky and over-zealous but I’ve found that things go wrong otherwise. And in the end it is always the patient who suffers and must clean up the bureaucratic dysfunction.
I assume @Patticakes got autocorrected because you are right, Medicare doesn’t call…
LCD - External Infusion Pumps (L33794)
For DMEPOS products that are supplied as refills to the original order, suppliers must contact the beneficiary, and document an affirmative response, prior to dispensing the refill and not automatically ship on a pre-determined basis, even if authorized by the beneficiary.
and
Suppliers must not dispense a quantity of supplies exceeding a beneficiary’s expected utilization. Suppliers must stay attuned to changed or atypical utilization patterns on the part of their clients. Suppliers must verify with the treating practitioners that any changed or atypical utilization is warranted.
The other fun thing in there is in addition to the prescription that the FDA requires Medicare requires a Standard Written Order for the same items. So next time you are at your docs office ask for a copy of the latest SWO for when you have to change doctors in the future in case the new doc isn’t as adept as your current doc.
I wish I could help @Patticakes. I’ve had trouble with both supplies and prescriptions this month and I’m not even on Medicare or use Medtronic. If I didn’t have spares it would have been bad.
It recently took me 6 months to get a pump RX to go through the meat grinder. Somehow, during covid, they bumped up my insulin dosage per day so high that I could get 30 bottles a month. I don’t have a reliable fridge, so I don’t, but I could. You gotta talk to them about getting you enough supplies to cover some inevitable hardware failures and enough insulin so that you are running right up against a wall. That is a miserable way to live. Did it for years. It was terrible.
Oh, I’m probably mistaken about the source of the call. It may have been Medtronic, now that you mention it, and probably OptumRX with the insulin. I think I’m losing it. When I need a new prescription, Medtronic contacts the doctor directly so I don’t know how he is writing the order. I will ask him at my next appointment.
Your information has been most helpful. Thank you.
The statement that Medicare requires suppliers to contact the beneficiary and receive an affirmative response prior to dispensing is interesting. My supplier never contacts me to ask if I need supplies. And, no I am not going to rock that boat—I have enough issues between my suppliers and my Medicare plan. My supplies arrive on time and in the needed quantity. (The “issues” I cited are of the accounting type.)