Our son is on the Minimed and the insurance (CVS/Caremark) company has removed the contour text strips from its preferred formulary. We have gone through the appeals for prior authorization and we have still had no luck. Has anyone else had this issue? I am floored that they will not cover the strips for a meter that "talks" to the pump.
Thanks for any advice:)
Bummer. I just ordered those for the first time and not sure if my ins is covering them or not. Wonder what Medtronic would have to say about that since they're pushing the Contour/Next meter.
I did not make the change over to the Contour meter when we got Eric's upgrade a few months ago (moved from a 4-year-old out-of-warranty 522 to the Revel) because MaineCare would only provide a single meter. I have 3 of the One-Touch meters that connected to his old pump, and lo and behold, they also work with the new pump — the prime difference, as far as I can see, is that they can't be uploaded to CareLink.
I think your best bet is to write to the people who manufacture the Contour and see if a) you can get them to supply you with free or discounted test strips, and b) if they might work on CVS/Caremark to reinstate their product in its formulary. It does not benefit them economically to have patients unable to access their product due to cost considerations. But in the meantime, find out what test strips ARE on the company's preferred formulary, because if they do allow OneTouch strips, there are OneTouch meters that will talk to Medtronic pumps.
Yes, our Endo is going to call Medtronic! I am actually going to give them a call too - something I haven't done yet.
I believe contour has a program to supply your strips and lancets. Go to their website. Also, my doctor had to write a letter to the medical director of my insurance and send medical records and explain why it was important for me to utilize this brand with my pump. They approved it for 2 years.
I am also on the MiniMed (523) and can no longer obtain my Contour test strips by email, but I can get a 3-mo. supply through my local retail CVS store. (I am on Medicare, which allows a 90-day supply through several retail pharmacies.)
I don't have the problem of my insurance not covering my Contour strips, but I did have a problem with how many my insurance will let me have. I needed a few more strips to last me until my shipment of supplies from Minimed at the end of this month. Plus, with the change the only strip prescription that my pharmacy has on file are the One Touch strips that I don't use anymore (I guess I could as that meter would still talk to my pump, but I made the switch last year.)
My new endo wrote me a prescription for Contour strips that got rejected. I went online and found a supplementary program from Bayer for the Contour strips, Bayer Contour Choice program, and then my pharmacist did some creative calculations and got me a 15-day supply that insurance and this program both covered.
That program might help take a bit of the sting off until you get this sorted out. It really makes no sense for any insurance program not to be covering Bayer Contour strips.
This is strange as Medicare covers my strips and lancets, which I pick up personally at my CVS store.
I had this exact same issue with the Contour and Anthem. CVS told me they will not cover it. I have not told my Doc yet so I'm hoping he can do something.
Thanks to everyone and their replies. I called the pharmacy and my "Angel" was able to get the prescription to go through via Medicaid who we have as a secondary insurance provider(thank you Davis for mentioning it)- . We got 300, praying that this will work on a continuing basis. Still not giving up on this - in terms of our first insurance provider.
Darnedest thing. I had a similar situation, but I had the Doc. write a prescription for the Contour Next and, voila, they arrived, covered by Medicare. (Obamacare has forced me off my company plan, which was just fabulous). Prior to that, they had told me that they would cover only the Contour, but not the Next, strips. It's no big deal to just enter the results manually so I figured I'd have to just deal with it.
I too am having the same problem with CVS/Caremark for the Contour strips. I talked with a rep from Caremark but was told there was nothing that could be appealed. I emailed Bayer to see about getting test strips and they could not help. I even called One Touch to see if I could get a replacement meter from them since Caremark will pay for the One Touch strips and they could not do that. So it appears as if one of the most crucial parts of the pump doesn't matter. This is very frustrating.
I have not found a loop hole yet, but I am still working on it. A couple of thoughts . . were you aware that Bayer has a program to help with the costs of contour strips -http://www.bayercontour.com/sections/shop/ContourChoiceProgram/FAQ. Also, My Dr. is going to call Medtronic and I am as well. In addition CVS/Caremark sent out a memo saying they would provide a meter. If you look at the bottom of this document it talks specifically about this. http://www.caremark.com/portal/asset/caremark_drug_list.pdf
I also spoke with someone outside of the call center ( I have his direct line) and he is going to send me the criteria in which my claim was denied (which we have a right to.) He also said we can send in another request for prior authorization if we find that we did not provide the needed information to get the test strips covered.
Not sure if this helps - I feel like Bayer or Medtronic should have some verbage available to help us get these test strips covered.
My insurance covers test strips as durable medical equipment, rather than pharmaceuticals. The CVS/Caremark listing of drugs does not seem to include any diabetic supplies.
Thanks for all the input on test strip strategies. I have the new Silver Blue Cross plan and am not sure what will be happening with my diabetes supplies. But it is comforting to know that we do have options. I can't tell you how much worry this has put me through. But this has helped reassure that there are options.
You can get a NovaMax Link that is still in production and will link to all the MM pumps, all including 530G. I have Express Scripts and they took every strip out of their formulary other than the One Touch. I still have a Ultralink and plenty of strips and I am getting in a few days a new Verio IQ with gold strips free and I don't pay any copay for the strips. I get 700 every 90 days from Express Scripts.
I am going to deal with this as well. I was to by Blue Cross/ Blue Shield that the strips ARE covered, but I just need to purchase them out of pocket and submit the bill to them for reimbursement. I go through my local Walmart and Expressscripts. I can’t use Expressscripts at at CVS.
Have you called you insurance company and their diabetes department specifically to get an official “NO” on this?
Otherwise, this really, really stinks.
I have a similar problem. I just got the 530G pump that links with the Contour. I have CVS/Caremark and they told me that I would have to pay full retail for them. I called my insurance and pointed out that they had just paid over $4000 for this new pump but I'm unable to make full use of it because of their lack of coverage of the strips. They said that One Touch is their preferred strips and they won't cover any other, not even in their second tier list. My old One Touch Link does connect to the 530G so that's what I'm using. It was suggested that I might get the Contour strips from Medtronic under the DME coverage but I haven't determined how much they would cost that way.
Aaarrrgghhh. This is so frustrating. In our case I eventually found out it wasn't CVS/Caremark it was my husband's employer who said no substitutes. I even contacted an advocate for insurance that deals directly with my husband's employer, but have yet to hear back. This is crazy! I guess in the long run the pump's cheap to insurance companies, its the test strips that add up over the lifetime. I have been through the gamut, the insurance company, Medtronic, and Bayer and no one seems to have answers. It would be nice if an insurance company that buys a pump would agree to provide test strips for the lifetime of the pump. I don't think that is asking for much.
In our fight, one of the steps I took was to have my son's Endo contact the Insurance Company and try for a preauthorization. It didn't work for us, but may be something you want to try.
I feel your pain.
Insurance? You just wait until you have to deal with Medicare!!They don't cover those particular strips nor the sensors for your meter.
I just went back to using my One Touch meter because those strips are covered by almost all insurance plans.....and even Medicare. Does the same job, just doesn't look as "hi Tech and cutting edge".