Seriously? You think no one in Medicare knows anything about diabetes, such as hypo-unawareness? Think dollars-at-stake in their decision making process; not ignorance of diabetes.
I made a visit to my local US Representativeâs office and met with legislative analyst who was very knowledgable of type 1 diabetes (childhood friend with T1D is now diabetes researcher) with a Medicare aged T1D who has had great success with a CGM. At the end of the day Rep. Karen Bass is a co-sponser of the CGM for Medicare bill. It was an oversight and we were thanked for bringing the issue to they attention. Support for bills is often driven by constitute requests.
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wow, good for you!
Has anyone ever conducted a study in adults on whether using a CGM results in fewer visits to the Emergency Room and fewer hospital admissions?
I believe that widespread use of CGMs would reduce hospital & ER costs to such an extent that it would actually save Medicare money.
Ever since going on Medicare nearly 45 months ago, I have been paying for my CGM out of pocket. Sensors on average last me 14 days. I order them directly from Dexcom at a cost of $305 for 4 sensors. The annual cost for sensors comes out to about $2000. The cost of a Platinum G4 and a transmitter should add another $700. My current CGM is 27 months old and I got 13 months on my last transmitter. How does this cost to compare to a Medicare paid visit to the Emergency Room or to an overnight stay in a hospital?
Medicare happens to be very good at negotiating prices for test strips. Wallgreensâ retail price for 100 One Touch Ultra test strips is $145. These strips can be purchased on Amazon for a little over $70. Medicare Part B has negotiated a price of $20.82 for these strips and they pay for 80% of that. Medicare supplementals often pick up the remaining 20%. Iâm sure that Medicare would be able to negotiate a significant price reduction for Dexcom products.
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Iâm not sure I agree with your assumption that a large number of insulin dependent diabetics (especially those on a pump) would end up in the ER often enough that it would be expedient for Medicare to cover CGM supplies, transmitters, and (for those systems that work independently of a pump such as the Dexcom) receivers. Have you got any data to justify that assertion or are you just hoping that that is the case and that Medicare will âsuddenly see the lightâ?
did you see this?
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The longer a person has had Type 1 diabetes, the more brittle they become and the less aware they are of hypoglycemic incidents. The pump delivers much more accurate doses of insulin. It cannot account for inset site absorption variability, unexpected drug interactions, illnesses, etc.
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The issue is NOT convincing Medicare to get smart about CGMs. Medicare knows what CGMs do and the value to many insulin dependent seniors. The issue is that CMS, through its rule-making power based on the current law, is convinced that the law does not provide for CGM coverage.
Therefore, IMO the only methods available to get CGM coverage appear to be:
- Get CMS to review their rule-making decision. (Ha! Thatâs not gonna happen!)
- Have one (or more) diabetics that have been demonstrably harmed by an âinappropriate regulationâ of the current law to sue CMS in federal court ⌠and win ⌠and then win on appeal ⌠and then win @ the Supreme Court. (Can you say prohibitively expensive?)
- Change the law to expressly allow CGM coverage for insulin dependent diabetics who meet certain conditions like hypo unawareness. (Possible, but still very difficult; requires a large number of advocates)
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As of now there are two bills in congress S804 in the Senate and HR 1457 in the house. Both have been sent to committee and there they will sit and die. Only two people can move them, Senator Orrin Hatch and House is Rep Paul Ryan
These are the only people. Call them, donât send an email call. Call your lefislators all of them.
As of now S804 has 50 cosponsors and HR 1457 has 140 cosponsors still climing
Need their numbers?
Orrin Hatch. 202 224 5251
Paul Ryan. 202 225 3031
Fill up their phone lines. 
Itâs the only way.
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4.---- organize large scale boycott of CGM until costs adjust accordingly such that people who actually need them can actually afford them.
This also has advantages in that it would increase access without strings attachedâ like bureaucrats deciding who actually needs a CGM and who doesnât.
I was involved in organizing a boycott of gasoline and heating oil on an island in Alaska once where price gouging was occurring. We brought down the prices of gas and heating oil by over $1 / gallon in two days⌠It really works. Of course thatâs a smaller scale exampleâ but economics work on any scale. Consumers actually have a lot of power
in the marketplace, but when the only discussion we are willing to have is how to get a third party to fund somethingâ weâve given all of our own power away, which is what Iâd like to avoid.
You can count me out. I hate boycotts. Iâll use what I want to use and no one is going to talk me into a coercive boycott. Furthermore, boycotting a life-altering product is more about the boycotterâs egos, than it is about personal rights and something I find patently offensive in its methods and itâs disruption of the usage of a product that can enhance ones life. Perhaps you like playing loose with other people livesâI donât.
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See above for textbook example of the type of attitude that has allowed medical costs to spiral out of controlâ at the expense of the people who need them⌠But pretty much everyone agrees with him too and thatâs the problem⌠Nobody cares what anything costs in medicine⌠And if nobody cares prices rise.
You really believe what you wrote?? How you can extrapolate from what I wrote, to that, is a bit of convoluted logic.
I not only believe it, I absolutely know it. The vast majority of the people receiving medical services and devices in the USA arenât paying for those goods and services themselves, thus they donât care what they costâ or theyâre only paying a small fraction of the cost, so they only care a small fraction what they would in any functional market. I drew the conclusion that you donât either by you pointing out that youâll do what you want regardless of the price gouging.
I further draw that conclusion because as seen above, people wonât even have a conversation about taking steps to reign in costs, the only conversation they are willing to have is how to require a third party to pay those costs-- a thought process in no way related to the costs themselves. Similar discussions can be found all over the Internet and all over society.
People can either chose to be part of the solution, or part of the problemâ when it comes to runaway medical costs in this country about 99.9% of us chose to be part of the problem (unknowingly) at least to some extent. Until that changes dramatically, prices will continue to spiral out of control, and access will continue to be challenging and limited for some.
If the rest of the country doesnât agree with me then they can just keep on doing what theyâre doing, since itâs working so wellâŚ
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Thanks for this @Lhovan49.
I just checked in @ congress.gov (here and here)
There are 153 co-sponsors in the House and 30 in the Senate. One of my Senators, Bill Nelson (D - FL) signed on as of September 8. My other Senator, Marco Rubio (R - FL) is perhaps too busy with his presidential campaign. I will contact both of their offices today to thank and encourage respectively.
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Sorry about my mistake in numbers got a email with some inflated numbers.
As you can see there is a dair amount of support they just need to be pushed overâŚ
Again Hatch and Ryan are the only ones that can pull the bills out of committee.
The more names and faces that can be attached to them the better.
Call folks good golly have everyone you know call.
Thanks
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I canm assure you that Medicare is well aware. Medicare is Federal law. The law has to be amended to incluce CGM coverage. I have been fighting Medicare thru their appeals process for almost three years. Many favorable decisions but then the Medicare contractor appeals the ALJ decision and overturns his decision. I am at the last step which is to go to Federal District court and the cost to do that is very high.
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@SueL, if you were to go ahead at the Federal District Court level and won, would that ruling set any precedence for subsequent cases? Or would the District Court ruling only affect you?
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@SueL, that would be a very ambitious move. I admire you for taking it to that extreme. The best of luck to you, if you proceed.
Terry, There already was a District Court Case in the stat of Wisconsin that was a win, but it did not effect the outcome of my appeals. You would think that if it was won in Federal court, it would set precedent. I cited the case in my MAC appeals but they overturned the ALJs dxecisions.