Medicare and no test strips with G6

So anyone else having problem getting test strips from medicare?Just switched to the dexcom G6 last month and not able to get test strips that dexcom was sending each month. Had my endo send a script for 150 test strips that they have not covered. My first G6 sensor was a nightmare and used 15 or more test strips in 24 hours. We need test strips, so what now? Anyone else having this issue?

Take a script to your pharmacy and try through them. That is what I do.

I had them send over a script, still wouldn’t go through.

Here is some information:: Blood sugar self-testing equipment & supplies
Blood sugar (also called blood glucose) self-testing equipment and supplies are covered as durable medical equipment for all people with Medicare Part B who have diabetes, even if you don’t use insulin .
Self-testing supplies include:
• Blood sugar monitors
• Blood sugar test strips
• Lancet devices and lancets
• Glucose control solutions for checking the accuracy of testing equipment and test strips
Part B covers the same type of blood sugar testing supplies for people with diabetes whether or not they use insulin . However, the amount of supplies that are covered varies .
If your doctor says it’s medically necessary, Medicare will allow you to get additional test strips and lancets . “Medically necessary” means that services or supplies are needed for the diagnosis or treatment of your medical condition and meet accepted standards of medical practice . You may need to keep a record that shows how often you’re actually testing yourself .
Medicare also covers therapeutic continuous glucose monitors (CGMs) approved for use in place of blood sugar monitors for making diabetes treatment decisions (like, changes in diet and insulin dosage) and related supplies . If you use insulin and require frequent adjustments to your insulin regimen/dosage, a CGM may be covered if your doctor determines that you meet all of the requirements for Medicare coverage, including the need to frequently check your blood sugar (four or more times a day) and the need to either use an insulin pump or receive three or more insulin injections per day .
If you have questions about diabetes supplies, call 1-800-MEDICARE (1-800-633-4227) . TTY users can call 1-877-486-2048 .
I would call my insurance provider. See what the glitch is. Good luck. Nancy50

Thank you for the information and phone # I spoke to Walgreens. They said that when they try to put it through that it asks if I am a CGM user and that I need to get test strips from my provider of my CGM supplies, I use Solara. I will have to try calling them again. Solara will be sending me my sensors from now on…Dexcom use to. I feel like I have been chasing my tail for the last few weeks.

Now that Medicare is covering G6, test strips will no longer be covered. As we all know, G6 does not eliminate the occasional use of test strips because that is in the G6 manual and we all know that sensors are occasionally wacky. So one could argue that maybe you would have a good chance of winning a Medicare appeal. I personally would just check out a meter and strips from Walmart or else buy Contour Next strips on Amazon. Fortunately I still have a stash of test strips and don’t have to deal with this yet.

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Laddie is correct. Because you’re on the G6 now, Medicare will only pay for strips and a BGM or the G6, not both. They view the G6 as being sufficient coverage to manage your treatment and pay providers a monthly price, thus not allowing any providers to bill for both. Your best bet is to find the cheapest stuff at walmart, costco, etc.

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Had a sensor that went wacky last week. That goodness I had strips. Also, what if your transmitter quits working and it takes several days to get a replacement.

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Go to Walmart and buy a set of Relion Prime. No Rx needed. You can’t be going without that now. Its needed. I forgot to stock those and I hate the idea of going into walmart, now. Maybe I can pick something up over the counter at Walgreens. There is currently community spread (widespread), so error on the side of going somewhere without a bunch of other people.

I am going to look into an appeal and in the meantime use up the strips I have. I did see the contour strips on amazon. No diabetic should be without strips. Who is making these rules for medicare?

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Not sure why you needed to use so many test strips.
I also just stared the G6 from G5 .
I’m only using two strips a day morning and evening even though it’s not asking for calibration.

Don’t even GET me started…
If you are going through traditional Medicare, they do not have any sort of predetermination/preauthorization, “pre” anything, at least as far as this issue goes. The only thing you can do is purchase test strips, send them the claim and, then, when they deny it, appeal.

Once that is denied you can fill out

There are several levels of appeals, the above form is for the first level.

Meanwhile, I would also “complain” (politely) to the appropriate Medical Director of DME
The US is split up into four jurisdictions (at least for DME).
Jurisdiction A : Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York - Entire State, Pennsylvania, Rhode Island, Vermont
Jurisdiction B : Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio, Wisconsin
Jurisdiction C : Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, Virgin Islands, Virginia, West Virginia
Jurisdiction D : Alaska, American Samoa, Arizona, California - Entire State, Guam, Hawaii, Idaho, Iowa, Kansas, Missouri - Entire State, Montana, Nebraska, Nevada, North Dakota, Northern Mariana Islands, Oregon, South Dakota, Utah, Washington, Wyoming
Jurisdiction B & C’s contractor is CGS Administrators, LLC.
Jurisdiction A & D’s contractor is: Noridian Healthcare Solutions, LLC.

The DME Medical Directors are :
Jurisdiction A : Wilfred Mamuya, M.D., PhD
Noridian Healthcare Solutions, LLC
PO Box 6727
900 42nd Street South
Fargo, ND 58108-6727
Wilfred.mamuya@noridian.com

Jurisdiction B : Stacey V. Brennan, M.D., FAAFP
CGS Administrators, LLC
2 Vantage Way - Metro Center
Nashville, TN 37228
stacey.brennan@cgsadmin.com

Jurisdiction C : Robert D. Hoover, Jr., M.D., MPH, FACP
CGS Administrators, LLC
2 Vantage Way - Metro Center
Nashville, TN 37228
robert.hoover@cgsadmin.com

Jurisdiction D : Peter J. Gurk, M.D., CPE, CHCQM
Noridian Healthcare Solutions, LLC
PO Box 6727
900 42nd Street South
Fargo, ND 58108-6727
email peter.gurk@noridian.com

I was just approved for the Dexcom G6 and was told that I could no longer obtain test strips.

I am glad the G6 eliminates the routine need for finger sticks, but there are times when I will need test strips. I guess I will just have to buy them out of my own pocket. I was checking prices online and they seem awfully expensive. I got used to the co-pay, which was affordable.

I wish they would allow a small quantity over a longer time frame instead of just cutting them out completely.

@Babs5 You definitely still need test strips. Dexcom even tells you that when in doubt get your meter out. But Medicare claims that unless it’s bundled together as needed, it means you don’t need them. I think it is how Dexcom got it approved but maybe also a cost saving factor on Dexcoms part. They wanted to farm out the dispensing of supplies to other companies and it saves money to not send test strips anymore with it.

But I’ve had the sensors 60 points off, how are you not suppose to check how accurate it is and the fact we are able to calibrate it by using test strips. It’s the stupidest thing.

Because G6 is FDA approved for insulin dosing in the USA, Medicare will not double pay for test strips. I have been on G6 since it came out. I have not done a finger stick in 18+ months. Learn the TRUTH about the G6 and develop some trust.

Here are some key points to ponder

CGM Calibration Thoughts and rationale to avoid pitfalls & rabbit holes

NOTE: The term “rabbit hole” comes from the 1865 piece “Alice’s Adventures in Wonderland” by Lewis Carrol 1865 and has come to mean a bizarre, confusing, or nonsensical situation or environment, from which it is difficult to extricate oneself.

Test by finger stick (FS) anytime CGM doesn’t seem to match the way you feel.

Learn & verify acceptable deviation according to FDA approvals, ±20% above 100mg/dL and ±20mg/dL below 100. Examples, CGM =200, then FS can be between 160 & 240 and still be fine, or CGM = 70, then FS should be between 50 & 90 with level CGM.

Wait 60 minutes between tests if testing for CGM for validation.

Remember, CGM measurements are interstitial fluid and finger sticks are whole blood.
Whole blood & interstitial fluid are physiologically different & 15-20 minutes apart in the movement of glucose.

Call tech support if 2 tests are >20% off, 1 hour apart. You may need a new sensor or have other technical issues.

Only enter calibration when tech support instructs. This reduces the number of times you will get into the calibrate, calibrate, calibrate hole.

If you are calling tech support for goofy sensor, request replacement, regardless.

Follow tech support about changing a sensor.

Avoid the calibration rabbit hole of the system requesting multiple calibrations for hours.

Not everyone (some doctors) who prescribed insulin fully understands CIQ.

Why Finger Sticks (FS) & CGMs don’t play nice together.

First, FS & CGM are only expected to be within 20% of each other according to published standards accepted in the US by the FDA. If your CGM says 200 then ±20% is ±40 mg/dL meaning a finger stick is fine if it is between 160 & 240. At the same time if CGM says 100 the ±20% would be 80 to 120. BELOW 100 it is ±20 points (mg/dL) without the percentage according to US FDA standards.
NOTE: Some individuals expect much narrower values between FS & CGM, even to the point of expecting them to match spot on.

Second, as food is eaten, the food enters the blood stream in various places along the digestive tract. Some enters quickly from the mouth, like granular sugar placed under the tongue. Other foods swallowed quickly may not enter the blood stream until arriving in the stomach. The final absorption occurs in the small intestine.

After food is absorbed into the blood stream, it is ‘checked’ by the liver and then dispatched thru the body in the blood stream.

After glucose is in the blood stream, the glucose moves in the liquid part of the blood (sometimes referred to correctly as plasma or serum - like serum or plasma glucose for the doc’s office or hospital blood test) into the interstitial fluid that moves around all body cells outside the blood vessels. It is this interstitial fluid that CGM sensor wires are in to read the glucose and report it to our measuring devices.

The time for all of the glucose movement to take place is usually 15-30 minutes or more, depending on multiple variables including the amount of carbohydrates, proteins, & fats in the consumed food which changes the way the food is processed in the body.

It is this 15–30-minute interval and body fluid differences that give significant part to the variation in CGM and FS readings. This is also the reason most comparisons are done when glucose values are demonstrated level by the CGM before doing comparison finger sticks.

Wish they would play nice together……

Originally with G5 and Medicare, the bg strips were covered as dme, and shipped together from Dexcom as a “bundle”.
Non-Medicare insurance did not “bundle” strips.

Some people have reported they can get strips covered by insurance, if they go through pharmacy with RX script from doctor.

I’m not on medicare, but get Contour Next strips as cash pay, because my insurance only covers one touch.

With Medicare, coverage for strips may be different based on standard Medicare vs Advantage plan.

I have a dexcom g6 and I generally don’t use finger sticks anymore. However there’s that once in a sensor where it’s not right.
I recently had one. It was chugging along in he 90s and went down to 44. I was really 150. So I took insulin and calibrated. But it happened again.
So I put in a new ina and it’s fine.
There was nothing obviously wrong. It just happens sometimes.
I think you do need some strips just for peace of mind.
Even if you have to pay out of pocket, they aren’t that expensive since you won’t use many.

I always do a finger stick several hours after starting a new senor. I do not calibrate until the following day if necessary. So the most finger sticks I do a month is 6.

You have to do finger sticks off and on, especially on a new sensor. They can be way off. This last new sensor I installed the evening before I went to bed, I turned off my phone at bedtime so I would not be disturbed by false readings from it. The next morning when I woke and it read my BG level as being 176, I get DP at various levels so I gave myself an adjustment and then it dawned on me, brand new sensor and I hadn’t checked it’s accuracy. Sure enough I was really 105 and then I had to eat. It took several calibrations that morning and a few later that night to refine it as I expect mine to be within 5 points of accuracy. I do not put up with them being 20 or 30 points off. If you know it’s that far off, no way can you trust dosing properly off of it.

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