Insurance Flags re Testing?

Hello! I had a weird experience today that I'm hoping someone can shed some light on. I have a prescription for test strips to test 10 times a day. I get a three month supply at a time (so 900 strips) from my pharmacy. I generally test more than 10 times per day and end up refilling the prescription as soon as my insurance will cover it, which is often less than three months.

Today, I went to pick up my test strips. The pharmacist said, "obviously you aren't testing 10 times per day since you are refilling so early." I replied, "yeah, haha, I test a lot; I like to know what's going on." He replied, "well it's a red flag for your insurance, so be careful." Then he left to go help someone else before I could say, "what are you talking about exactly?"

Anyone have any idea what he meant? Thanks so much!

My experience is that insurance won’t pay for any more strips that the prescription is written for. So if you are renewing significantly before your strips would run out if you only tested the amount prescribed, insurance may not renew. The red flag, I think, is when the insurance company’s computers indicate an early enough renewal date that you should not really be out of strips, if you were testing only as prescribed. To the computer its like you are abusing strips. Like taking too much pain killer or something.

My Dr. only prescribed twice a day. I test 7 times a day, before and after every meal and once at night. So I run out quicker than the insurance company expects.

You should not have any trouble buying strips outright (i.e. without insurance coverage), but beware the price. I buy additional strips off the internet at half the cost as over the counter at the pharmacy.

They think you are not testing as often, but instead selling the strips on ebay, I suspect.

Talk to your endo and have him/her increase the daily amount.

Why don’t you get an RX for testing more often?

Doesn’t it mean if you’re refilling early that you’re using MORE than the 10 per day not less!? That’s why you’re running out and having to refill sooner? It may still send a re flag to your insurance, I’m surprised you can refill sooner, when I try they plain turn me down because it’s too soon.

My insurance will only cover 10/day. YET they will refill early (before the 3 month mark). They won’t refill ANYTIME, (ex. I couldn’t pick up one batch and another batch 2 weeks later) but they will refill two weeks prior to the three month mark. It’s very odd; I don’t pretend to understand the rationale.

Yes, that’s right. I test more than 10 times/day. I often have to wait like you do until the date they give me that’s safe to refill, but that date is usually two weeks-ish before the actual 3 month mark. I buy test trips online to supplement the gap in refills.

Yes, I’ve noticed that as well; that all my medications come up for refill before the actual date they would expire. I’m not sure why that is. On my pain meds vial (the only one I fill at the drugstore rather than by mail) it actually says “Most insurance allow refill on or after…” and the date is 6 days early on a one month prescription. Usually I fill it at the month or later, but once I went in a couple days sooner and she said, “it hasn’t been a month”, so I showed her that sentence on the vial and she went ahead and filled it.

I would ask the doctor to write it for more and see if the insurance will approve it. My doctor (who doesn’t see many type 1’s) had thought he could write much less than I actually use, but then someone on here who had Medco like me was getting the 10 a day so he tried it and they approved. i also think there is some kind of overwrite they can use to write it for more than the usual amount (whatever that is)

That’s all my Doc did was write the prescription for the amount I need whether it’s 7, 10, or 12. I test7-8 times and he wrote it for that and insurance covers it, no problem. My problem is like you , if I’m having a bad month and need to test more, I come up short and with delays and confusions on the store end I am right on the edge. Since I’ve gotten my CGM I’ve been testing a little less so I’m hoping to build up that reserve again.

I own a diabetes supplies company and diabetes pharmacy and I will tell you that you should not be paying out of pocket for you testing supplies. If you are using 10+ teststrips a day to keep you healthy your insurance should cover you for the 10+ so long as your MD agrees and writes a prescription for that amount. The only way that the insurance will not cover the testing amount would be if your policy specifically states a limit on your supplies but even with that if testing at high amounts is medically justified and keeps you healthy , it should and can be covered. It may take some work on the pharmacies part to get your insurance to ok the amount but it can be done. We have type 1 customers that are cover for testing 20 times a day.Your pharmacy should have helped you to get what you need.