Interesting…I haven’t run into this yet.
It is entirely plausible that that Medicare has decided you have to get your test strips through a sensor supplier. People mentioned getting their supplies through DexCom. That option isn’t available to everyone. Assuming those people have Medicare, I will say it actually surprises me because Medicare typically requires that the supplies come from a third party (like you are doing). I can only guess that the same may not be true across the country. (In some things, Medicare is not totally the same across the United States).
Back with the whole competitive bidding stuff the “mail order” diabetic supply companies that received the contract would only work with certain glucose meter companies (and they would REALLY try and push the person into “Off Brand” meters) then, as time passed, they suppliers that had the contract started to fade away in offering the “Big Four” (Accu-Check, Freestyle, One Touch, or Contour).
I hadn’t heard competitive bidding was suspended but, even if it has been, most of the DME supplies are going to still not carrying the “big four.”
That being said, if you are unable to get your supplies from DexCom (this is something Medicare may be dictating) and you HAVE to use Byram I would start complaining to Medicare.
If it were me, this is what I would do:
From what I understand Medicare (DME or durable medical equipment) is split into four jurisdictions.
Jurisdiction A: Connecticut, Delaware, District of
Columbia, Maine; Maryland,
Massachusetts, New Hampshire, New
Jersey, New York, Pennsylvania,
Rhode Island and Vermont
Jurisdiction B: Illinois, Indiana, Kentucky, Michigan,
Minnesota, Ohio and Wisconsin
Jurisdiction C: Alabama, Arkansas, Colorado,
Florida, Georgia, Louisiana,
Mississippi, New Mexico, North
Carolina, Oklahoma, Puerto Rico,
South Carolina, Tennessee, Texas,
U.S. Virgin Islands, Virginia and
Jurisdiction D: Alaska, American Samoa, Arizona,
California, Guam, Hawaii, Idaho,
Iowa, Kansas, Missouri, Montana,
Nebraska, Nevada, North
Dakota, Northern Mariana Islands,
Oregon, South Dakota, Utah,
Washington and Wyoming
Each of these jurisdictions has a medical director in charge of it:
Jurisdiction A: Wilfred Mamuya, MD, PhD
Phone (701) 277-2789 Fax: Not listed
Jurisdiction B: Stacey V. Brennan, MD, FAAFP
Phone (615) 782-4662 Fax (615) 660-5997
Jurisdiction C: Robert D. Hoover, Jr., MD, MPH, FACP
Phone (615) 782-4476 Fax (615) 664-5955
Jurisdiction D: Peter J. Gurk, MD, CPE, CHCQM
Phone (701) 277-2603 Fax (701) 715-9485
(At least as of 2018)
I would contact the person in charge of your jurisdiction and I would say something like this:
Dear Dr. ?,
I’m am a Type 1 diabetic dependent on insulin who is currently using the Medtronic MiniMed 630G insulin pump and the Dexcom G5 continuous glucose sensor to monitor my diabetes. I have met Medicare’s criteria for coverage for both of these devices.
As part of my Medtronic insulin pump system I also use the Contour Next Link meter to monitor my blood sugars. This is the ONLY glucose meter that is capable of communicating to my insulin pump. As required by Medicare for use of the insulin pump and DexCom G5 I test my blood sugars using the Contour Next LInk a minimum of four times a day (you could say the actual amount if you want but NOT less than 4 times a day). I do not have DexCom G6, which is the only sensor that is FDA approved to be used without calibration monitoring so I MUST use a glucose meter and glucose test strips to comply with Medicare’s requirements.
Recently, I have run into trouble obtaining those test strips. I had previously obtained them through Walgreen’s but I have been informed that, since I use a continuous glucose sensor, I must obtain the test strips from the same supplier as the one who does my sensor supplies.
I have contacted Byram, who is my durable medical equipment supplier (DME) for my DexCom supplies and have been informed that they will not fill the test strips I need. I have been told that the only test strips they will provide are called Wave Sense. This is a problem. That meter cannot communicate to my insulin pump and it is essential to my care that I have that capability.
My understanding is that I have to use Byram for my Dexcom (and Medtronic?) supplies. There are very few DME suppliers that deal with insulin pumps or continuous glucose sensors so my option of suppliers is limited.
From what I understand there should be no reason why I can’t obtain the Contour Next test strips from Medicare’s point of view. Byram just refuses to provide me with test strips requested.
I have spoken with both Medicare and Byram and can’t seem to get a resolution. My testing supplies are getting low and I have a short time in which sort this matter out. I really need some assistance and/or direction in this. Is there a way I can continue to obtain my testing supplies through my local retail pharmacy as I have been doing or is it really necessary that I obtain them from the same supplier as my sensor (and pump?) supplies? If I can obtain through my local retail pharmacy then why is the claim being denied and the pharmacy is being told that it has to go through my DME supplier? If Walgreen’s can do it then how do we fix it so that they are doing it?
If I HAVE to go through the DME supplier then why aren’t they giving me the supplies I need? My glucose meter is part of these supplies. This particular meter comes either from Medtronic, or Bayer- the meter manufacturer- directly. It is not something that you can obtain through a local pharmacy since is strictly used in communication with the Medtronic insulin pump. How can they fill part of my “pump supplies” (though don’t use quotes in the letter) but refuse to pay for the other when it is all covered by Medicare and I have met the criteria for coverage?
Any help in this matter would be greatly appreciated. Understandably, I’m very nervous about this mess. I CAN’T run out of testing supplies. In addition to it not being safe or good for my health, without the supplies I can’t met Medicare requirement of testing four times a day to continue to qualify for the pump without test strips and I’m worried this will put getting my other supplies at risk of being denied.
Thank you again for your time.
That is a basic idea of how I would approach it.