Medi-Cal is proposing changingtheir policy for testing strips and lancets that will be supplied under their program.
They are limiting 150 testing strips & 100 lancets/claim & 3 claims in 90 days for insulin users. Those who do not use insulin are limited to 100 test strips & lancets per 90 days.
These limits can be altered if your doctor & pharmacy provide documentation to "demonstrate" a need in excess of this. But these have to be repeated with every claim. Meaning a delays for getting documentation and a delay in getting approval by Medi-Cal.
The Calif. Dept. of Health Care Services is meeting on September 27th. It is not open to the public! And there is no system in place for public input, nor are they seeking it.
I suggest sending email immediately to Pansy.Watson@dhcs.cal.gov Pansy Watson, R-PH
Chief, Medical Supplies & Enteral Nutrition Benefits Branch
Medi-Cal Pharmacy Benefits Division
California Department of Health Care Service
Seems very shortsighted. If you are trying to control DM w/o medication this is just another bureaucratic barrier. And some DM are not that predicatable, such as those who are pregnant or in an unstable period of control, or period of stress.
At the very least, beg that if a limitation is placed on supplies, that documentation covers at least 6 months, or a year.
They will cover CGM though, but you cant qualify for Medical unless you have no job or are homeless, I thought.
I looked into it when i lost my insurance and no one would cover me, but the income level is at poverty level I think around $18,000 a year.
I do have insurance through MRPIP which is government run, but I have to pay for it. its about $450 a month it is ok , not great BUT IM GLAD I CAN GET SOMETHING.
My insurance made a new decision to reduce testing too, they made it an across the board 70-30 coverage, so I pay 30% copay, but i can get unlimited strips.
Thanks for the comment I hope you will email Pansy Watson today at Pansy.Watson@dhcs.cal.gov and let her know your objections. I am not in the program, but figure I will be someday. And I worry about this being a snowball gaining size - if they do it, can any of the private insurance be far behind?
Please let them know that they are making it far more difficult for those of us with diabetes to keep it under control and advoid short term consequences like hypoglymic incident and long term complications because of poor control. The cost of the strips has to be offset against the cost of those complications (should be no comparison) and the human cost of unnecessary suffering.
Hey all - I'm thinking we should make a petition and circulate among TuD and other social media outlets today to get as much input as possible. This is horrible news. I'm a social worker in a diabetes clinic as well as a T1, and I know this will negatively impact many. I believe we need to stick together as PWD's - like Brent said, even if you're not on the plan you may be someday, and other states may try to follow suit. We're in this together. Thoughts?
And this is what Diabetes Hands Foundation received from Medi-Cal in response to our inquiry about it:
Medi-Cal is proposing a change to its policy on utilization controls for testing strips and lancets. (Pursuant to Welfare & Institutions Codes 14105.395 (a) ) The proposed change would place a limit on the number of testing strips and lancets allowed for each claim without an approved authorization for insulin users. The limits would allow 150 testing strips and 200 lancets per claim. It would set a limit of three claims within a 90-day period. Those who do not use insulin would be limited to 100 test strips and 100 lancets per 90 days.
Claims for quantities greater than the maximum allowable would be available through an approved authorization process with documentation of medical necessity. If a beneficiary regularly uses quantities greater than the maximum allowable, new documentation must be provided every six months. The California Department of Health Care Services will meet and consult with provider representatives on September 27 to discuss the changes. Since the proposed change does not eliminate the benefit, public notice is not required.
Yeah our diabetes clinic got the notice that Medi-Cal put out - which only allows 5 checks per day for those taking insulin without jumping through hoops. For kids we who have this insurance and often have trouble making their clinic appointments alone, this will be a barrier. Esp since we recommend checking 6 times per day!
Dear Katie, Access to blood glucose test strips is at risk for low-income Californians with diabetes.
The California Department of Health Care Services (DHCS), Medi-Cal Division, is proposing to restrict the number of blood glucose testing strips for beneficiaries from six test strips per day to five per day for those using insulin and to one per day for those not using insulin to treat their diabetes. This proposal is dangerous and California Advocates need to take action to halt it in its tracks.
Click here NOW to tell DHCS access to blood glucose testing strips is critical to diabetes management! The deadline to hear from us is THIS FRIDAY, so don’t delay.
