I am facing going on Medicare next spring, and I have heard that Medicare will only cover a three-month supply of insulin and test strips at a time. That, of course, means that I will have to see an Endocrinologist every three months for those prescriptions rather than the six-month visits I currently have. Is this true?
Pretty much. Unless endo will work with you on how much in script. Using Dexcom CGM so I am definitely stuck with 3 month regime.
You have to have see an Endo every 90 days to get supplies - true
The scripts can be written for a longer time
the visit is mandatory
Well, no. Individual endo’s may require more frequent visits. But I get some Medicare prescriptions from my GP (test strips, insulin, etc.) and my Freestyle Libre supplies from my endo. And while I can only order a three-month supply of most of these, the scripts are written with multiple refills. The Libre supplies are only for a month, but again, I just order refills from the supplier.
If my prescriptions expire, the pharmacy or online supplier just contacts the doctor and requests a new prescription. I’ve been getting insulin and test strips for multiple years on Medicare. I see my GP twice a year. Up until last year I didn’t even have an endo. I think currently CGMs do require more frequent endo visits to verify you are really using them. Not sure how that will shake out in the long run.
The place where my wife gets tubing wants a date proving you have seen an endo in the last 90 days
Thanks for the reply. I am on OmniPod pump, but no CGM. I have thought of a CGM but am not going to do anything right now until I see what Medicare will do for coverage. Having to see an Endo every 90 days just to get CGM supplies may dissuade me from going that route altogether, even though I know I would be healthier if I got a CGM. Ironic, right? Medicare makes getting supplies that will keep us healthier (and thus, cost less in the long run) difficult. I guess “prevention” is not a part of their vocabulary. I have a great Endo, so I am sure that she will be very accommodating with writing prescriptions that will work in my best interest.
(Sigh.) I winter in Florida and summer in Wisconsin, so now I will have to have an Endo in both states. My Endo in Wisconsin is really great, and I have worked with her for years. She does all my prescriptions on a six-month or yearly basis. Just the expense of going to another doctor just to get supplies to keep me alive really is irritating. I don’t understand Medicare’s reasoning.
DiabetesOldie, does Medicare require that you go through a particular online supplier? I was looking forward to NOT having to use EdgePark which my current insurance requires.
Yes, you need to have a specific online supplier, but I got to choose one of six. I chose Byram and so far, so good.
I think I heard that Medicare will now cover Omnipod but under the prescriptions component or Part D. Not the greatest but at least they are acknowledging other ways to manage T1
They are coming into the 21st century kicking and screaming.
I don’t see any drawbacks to applying for a CGM through Medicare. Even if it takes you some months to get coverage, you will eventually get there. You do need to keep records, but that shouldn’t be that onerous. The main sticking point for me was to show that I was taking four BS readings per day minimum. And that I was adjusting insulin dosage based on those readings. You already have a log of you blood sugars because the doctor can read your meter. So, you just need to keep track of your injections and meals.
Talk with your endo — they can tell you how to jump through the hoops without seriously bruising yourself!
The crazy thing I have to continue doing is to take four BS meter tests each day, even though I’m on a CGM. So, I dutifully do the four fingersticks each day. And I record my insulin shots and meals right on my Libre reader. It’s crazy, but it’s a small price to pay for what I get out of it. It’s my opinion that anyone who says they understand Medicare doesn’t understand Medicare!
As I understand it, a pump user under Medicare has to see an endo every three months to be approved for pump supplies. I’m on MDI and only need to see an endo every six months to get my insulin and test strips.
I have a Freestyle Libre CGM and under current rules only need to see my endo every six months to get approved for sensors. That could be changing. But I doubt that the rule would currently be different for a different CGM.
I don’t understand why you need to take four fingersticks a day. I have a Freestyle Libre, and most days I don’t take any. My endo doesn’t require it. I don’t see anywhere that Medicare requires it. I’m not even bothering to have Medicare pay for my glucose strips since I got my Libre, since I use so few strips it isn’t worth my trouble to keep track.
The only thing I can see in the rules is that if you want to continue to be supplied with four strips a day that you have to prove that you are actually using them. Just don’t use them and don’t have them supplied and you have nothing you have to prove. That’s what it looks like to me. Am I wrong?
You are most likely right on all counts! I could never find anything in the rules either. My endo says Medicare contacts them regularly and wants to know that we are doing the fingersticks and basing insulin on testing. Note that I don’t even get my strips via the endo. Ask them about these rules and their answer is — we’re dealing with Medicare!
Perhaps they’ve misinterpreted how this works? But for right now, I’ll do what it takes to keep getting supplies. I would also note that the Libre can easily be off 10 points in the low end of the range. So, I would be doing a couple of fingersticks each day anyway.
Also, I think I was their first Libre patient. So they may well be going on their experience with Dexcom.
I’ve only had a couple of visits with this endo, so when I’m firmly on the Libre reimbursement program, I’ll be asking again.
I’m also one of my endo’s first Libre patients, so I expect that his experience with Medicare in that regard is also limited. But my understanding is that the reason Libre was approved for Medicare reimbursement was that the FDA does NOT require that dosing be done by fingersticks. That is, not if the Libre result isn’t in the category (mostly close to high or low end of acceptable range) where the blood drop is showing on the meter. In that case, a fingerstick is advised before dosing or treatment.
What I find is that most of the time when my Libre shows hypo range, it is because I have been lying on the sensor. I no longer bother to do a fingerstick reading when I suspect that. I just wait five minutes and test with the Libre again. If the “hypo” was due to compression on the sensor, the reading would typically be 10 or 20 points higher than previously. If the reading is still low, my experience is that the reading is then close to “right on” and I don’t bother to BG test, I just treat. Of course, I’m underweight so if I eat a little more than necessary, for me it is no big deal. Not everyone thinks that way.