I got my first prescriptions filled as a Medicare recipient (on an Advantage plan) at CVS yesterday. I was told that medicare will only cover 3 test strips a day for type 1 and 1 test strip a day for type 2? Is that correct? I am in limbo with all my cgm supplies since the change over this month. I’ve had a Tandem x2 and a Dexcom G6 for six months or so, and though I had no trouble getting pump supplies with medicare, I have had a very difficult time trying to get the CGM supplies. G6 is not OK’d for Medicare, they say, but G5 is within the plan… but it was a search to find a DME provider that would supply a G5 and the receiver and transmitters. I’m wondering what the factors are? Has anyone else had difficulty? Any clarity you can offer? My last G6 sensor is going to quit tomorrow and it will be at least ten days or a few weeks
(and as long as there aren’t anymore surprises) before I get the G5 replacement. And if I can only get 3 test strips a day…? Yikes.
I’m on a Medicare Advantage Plan and my Endo prescribes 5 strips per day. The pharmacy submits it under Part B and I get 150 per month at no cost. However My Medtronic CGMS supplies are not covered.
I am on Medicare and get my Dexcom supplies directly from Dexcom. Currently on G5 and Dexcom sends me up to 150 strips per month depending upon how many I tell them I need each month.
My current Rx is for 300/month thru Medicare, via Dexcom. All you have to do to get more than the standard allotment is to have your doctor fill out an Rx and a “quantity override” form if applicable. No big deal. You’ll get what is “medically necessary” and your doctor has to provide info that you are using the amount requested. I just print out my meter data and bring it to each office visit. The report states the average number of tests per day.
Thanks, Don. Do you know why your CGM supplies aren’t covered? They’re supposed to be covered by Medicare Part B as well as I understand it.
OK, so Medicare will provide enough test strips that allow you to keep decent track of your BG’s, with a Dr’s prescription. I thought the 3 a day limit was an absolute. Thanks!
Dexcom is approved (G5, G6) by FDA to use for dosing, without fingerstick, so MC approves. Medtronic CGMS does not have FDA approval for dosing decisions.
G6 will be available to medicare users later this year.
The FDA has not yet approved the Medtronic CGMS System. Apparently, because the Medtronic CGM controls the flow of insulin, the FDA needs more testing before it will approve the system. Accordingly, Medicare will not approve the system until the FDA approves it.
I was told by Byram that since I started on the G6 prior to being Medicare-eligible, I would continue to receive my G6 supplies, but sensors would only be sent 1 box/order, IOW, a 30 day supply.
I received my first 30 day supply today.
Let me say that I feel your Medicare-transition pain. I started the re-order on June 5, and only received the sensors today after multiple calls to Byram. It’s a long and painful story that I’ll share on another post.
I am a long time well controlled T2 I get 2 strips a day, someone thinks I don.t need anymore because I am well controlled. Oh well. I supplement my allocation with CVS Advanced strips record the same as One touch. Mini. And is affordable, at least for me.
Because of this, occasional bad sensor, vacation/travel dates, order delays and screw ups, doctor notes a few days late, change of medicare ID numbers and a whole host of other things that can and will go wrong, we extend sensors so that we build up a few spares to cover us for these events, delays and peace of mind. Same goes for test strips. I am medicare patient on Dexcom G5.
I can only get enough for 3 a day, 90 a month, and had to fight for that. I am a well controlled Type 2 but at times I get a low. My doctor wants 5 a day but Medicare told me to look into my own personal resources (their words). I buy my own extra just in case for those times I am sick or the test trips don’t work. I did get 50 a month. My doctor wrote them for 90 a month. That’s the best he could do.
Maybe because u are type 2? There are some store brand strips that are reasonably cheap and the meters for them are also very low cost.
Type 1/2 or anything in between makes no difference on Medicare allowable number of test strips.
OK, then explain to me why I can get ANY quantity I like. I’ve gotten over 400 strips per month, ON MEDICARE. It is all about the doctor knowing how to fill out paperwork. Nothing more than that. My meter showed an average per day of 17 strips.
You explained it yourself right here. Has nothing to do with diabetes Type, yet everything to do with how the doctor fills out the paperwork. Nothing more than that.
But I don’t know squat about the rules for Type 2’s. Hence I asked. I AM allowed to do that, am I not? And I STILL don’t know what limits they have for Type 2’s. If anyone has a link to their rules, that would be awesome (for T2’s)
I am not sure what the limits are for Type 2 either. For legal reasons I can’t go into here about 30 years ago I was listed by Joslin as a Type 2 to qualify for a beta program they were running that very few people had the qualifications to enroll in. I was told my records would be showing me as Type 2 but I would be treated as a Type 1. 2-3 years ago or so Joslin wanted to clean up my records and relist me as Type 1. They ran a bunch of tests starting with C-Peptide and found that I was actually not type 1. After reviewing all their records and protocols they determined that I had to be MODY because that was the closest I came to anything with an I:C ratio of 1:3 and other criteria. They said they could not pay for the MODY test because neither my grand parents, parents, brothers, sisters, children or grand children are diabetic.
To clean up the record I told them I could afford the MODY test to get this resolved once and for all. MODY results came back negative. So to this date, Joslin has not been able to type me and still has me listed as a Type 2 in the meantime.
Long story to get to the point that I am on Dexcom G5 Medicare listed as Type 2 and I fill out the monthly Dexcom form to tell Dexcom how many test strips I have left and on that basis they send me up to 150 test strips so I certainly know they allow more than 1,2,3 or even 4 test strips per day as I can get up to 150 every month which works out to about 5 strips per day.
What I don’t know is if my meter downloads show needing more than 5 strips a day are required, if I could get more as I have never required more than 5 strips per day since being on Dexcom G5 and therefore have never had to ask endo for a prescription for more than 5 strips per day.
Hope this clarifies my situation and why I don’t believe Type of diabetes limits you to less than at least 5 strips per day.
OK, here is the deal on Medicare and G5 users. The STANDARD amount (that means u don’t have to provide proof of strip usage) is 150 strips per month. That much I know. My wife and I started out getting the 150 that medicare provides to the G5 patients. In addition, we got additional strips thru Walgreens. Then, late last year (around Oct or Nov) Medicare denied the strip coverage thru Walgreens. It turns out that they changed the rules a bit to require that all strips come from the same supplier which in our case is Dexcom. So I called my doc’s office and had them fax a new strip order to Dexcom and voila, the next month I began receiving 300 (6 boxes instead of the usual 3) strips and that’s how it’s been ever since. So to recap, if someone is on Medicare and getting the G5 they are automatically entitled to 150 strips per month. Not only is that what I know from personal experience but I’ve discussed this stuff with Dexcom folks which explains the 150 strip thing is “automatic”, but can be increased by documentation from the doctor.
PS, my strip usage has declined and now I opt to get less than the allowed 300. The G5 is so accurate for me, I rarely need to test. (Soaking each sensor for a day helps too!)
I used to get 150 strips per month from Walgreens but screwed up and “forgot” to order them through Part B so charged me $30 co pay. I switched to RiteAid and received 200 strips at no cost instead of 150. When I inquired about the increased quantity, I was advised that the pharmacy only stocked my Contour Next strips in containers of 100 so rather then special order order a box of 50 it was easier to give me 2 containers of 100.