(I’m responding to this post via e-mail instead of on the website, so I’m not sure it works)
I guess I just don’t understand the intention of the rule you describe. How does it in any way potentially defraud medicare if you conduct a transaction for a prescription med that a doctor prescribed, completely outside of medicare?
PS I’ve never been asked for ID at a local pharmacy unless picking up narcotic class meds. And there’s really nothing in my mind wrong with just saying “I’m a cash customer.” The pharmacists job is to ensure the meds are properly and dispensed according to the prescription— frequently they cant even process the insurance and just sell it cash and tell the customer they can submit it to their own insurance, in my experience anyway…
I didn’t know all of that re: medicare. Strikes me as an absolute invitation to corruption instead of a mechanism to control it. Even so, well worth buying cash. :
Even if it costs $350/ box of tresiba (for u200 is 1800 units = 3 pens) and someone uses 20 units / day… that’s a 90 day supply and the cost is less than $4 / day in that example. I made those numbers up so I’m sure that’s not exactly the accurate cost, but I’m just illustrating the point that as long as I can afford internet access to come here and chat on forums, I can certainly afford the best insulin on the market, because they’d cost me less than a fancy coffee from starbucks each day…
Terry4 is correct that this is tied into anti-fraud regulations within Medicare. Does it make sense? Absolutely not. But it is the law. So if I am in Medicare and there is a $99 upgrade to a newer model of my pump (.for example, the Animas offer to move to the Vibe from the Ping), I am not eligible if I am a Medicare or Medicaid recipient. It’s not the pump manufacturer forbidding me. It’s Medicare law.
I don’t think it matters if I am a cash customer. For example, I may have gotten my Animas Ping before I went on Medicare and thus Medicare did not pay for the pump. However, I was not eligible for that upgrade if I was on Medicare when the Vibe was released. Doesn’t matter if I was paying the upgrade fee myself. They are forbidden by law from letting me benefit from the upgrade.
Back to the original question I switched a month ago to Tresiba after 20 years on Medtronic/Minimed pumps. I fully expect my A1C to come down at least 1.5 points, but I’m shooting for 2.5. Why did I switch? I had gotten lazy on the pump. All that data locked inside of it, and I never downloaded my reports, would eat anything and give myself an Easy Bolus without even looking. MDIs are forcing me to record my BGs on a phone app, and the app gives me an estimated A1C that really motivates me to do better.
It’s also really nice to be unattached after 20 years of clipping the pump to my underpants at night. Another benefit: no sudden, catastrophic pump failures (I’ve had 10 or more on Medtronic (not Minimed) pumps), and no cellulitis at the insertion site (I’ve had this three times, with one landing me in the ER and another that would have if I hadn’t had a doctor who was a friend call in some drugs).
I do miss my integrated CGM but haven’t been able to afford that for 3 years anyway since changing jobs and insurance.
I’m probably unusual–there are many people on here who are far more conscientious than I am–but I needed something to shake up my routine and force me to pay attention and keep a log. Shots never bothered me. They do make me consider whether that bite of high-calorie food is really worth poking myself.
Oh, and I used to have what I thought was a strong dawn phenomenon, but Tresiba covers it. Waking up with BGs of 102 most days. Wow! I’m really happy. Can’t say I won’t go back on the pump someday, but this is working well for me now.
Really? The private insurers I have suffered with all my adult life have been FAR from paragons of logic and sensible policy. That’s not an excuse for nonsensical policies, but the government does not have a monopoly on that when it comes to health care.
Sorry – I can’t ignore. So you think the fine upstanding corporate citizens like the company, Mylan, that sells $600 epi-pen kits are much better stewards of administering our health care system?
Frankly I think the only solution is some sort of national government-sponsored healthcare. But I know that we need to be careful what we wish for. In most countries, most of us would not qualify for pumps and certainly not for CGM’s. At the same time, people are able to get the basic necessities of pens/syringes and insulin.
I didn’t say that, @Terry4 - I am a proponent of letting our healthcare providers determining what is the best course of treatment. I see too much fraud in Medicare to trust the government to run things, and the corporate drug companies are only considering profits.
I switched a month ago to Tresiba after 20 years on Medtronic/Minimed pumps. I fully expect my A1C to come down at least 1.5 points, but I’m shooting for 2.5. Why did I switch? I had gotten lazy on the pump. All that data locked inside of it, and I never downloaded my reports, would eat anything and give myself an Easy Bolus without even looking. MDIs are forcing me to record my BGs on a phone app, and the app gives me an estimated A1C that really motivates me to do better.