Medicare No Longer Covers Test Strips for G6 Users

I went on Medicare in March 2019, and Medicare covered my FreeStyle regular test strips under Part B for use with my OmniPod pump. My supplementary insurance actually picked up the rest of the charge. (Nice surprise!) I needed to refill the test strip order this week, but since I have gone back on the Dexcom G6, my pharmacy told me there was a delay due to insurance problems. When my Endo’s office tried to get the strips for me, they were told that Medicare would not cover test strips since I was a G6 user, and the G6 does not require calibration. (Not such a nice surprise!) I am amazed at the ignorance of medical conditions that Medicare authorities display. Can I input glucose readings from the G6 into my pump? Yes, but I have found that the two are not always within the 15% difference in readings range, so I do not totally trust the G6 readings. And what if the G6 says I am fine, but I know from my symptoms that I am not? What happens when I lose signal (which happens often when I first start or am ending a 10-day session) and I need to take insulin to cover a meal? Medicare seems to be saying that as a G6 user, I need no back-up system. I have never gone without a back-up/ confirmation system, and it has kept me alive with diabetes for 53 years. Has anyone else on Medicare and using a Dexcom G6 CGM had trouble getting test strips covered?

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Do you have Advantage plan? Their rules may be different than MC.

Your life is precious. At .30-.40 a strip bought in bulk delivered for contour one next which is the recommended strip for Dexcom, does it not make sense to buy a few batches until this all gets sorted out? Depending on insurance coverage with Co-pays, 1/2 the time it is cheaper to buy some diabetic supplies for cash rather than process through Medicare. Just maybe worth looking into.

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It’s ridiculous that they think you don’t need any calibration. Or to check it’s accuracy ever. Even the Dexcom site says when in doubt pull your meter out!!! Unfortunately that’s the government run system.

I know when I had a sensor that was off (gee I had to test to know that) Dexcom said a 30% difference was okay. Mine froze so they replaced it anyway. But the point was I was supposed to be okay with dosing myself when it said I was 92 and I was really 69 or when it said I was 120 and I was actually 150. No way no how is that okay. One I could kill myself and the other I could end up with a skyrocket BG level.

The problem based on my understanding is that SherryAnn is in limbo land. Medicare has approved the G6 which she has but Dexcom is not yet ready to ship the G6 to Medicare patients until the latest date being September 2019. Since Dexcom does not direct ship Dexcom G6 to medicare patients at this time, Medicare will not pay for anything G6 related. It is really a Dexcom issue, not a government issue as the government is ready to pay as soon as Dexcom is ready to ship complete systems that work to Medicare patients.

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No @CJ114, She is saying Medicare won’t approve test strips while she’s back on the G6.
It supposedly isn’t needed while you are on it. But you did make me reread the post lol…

I’m confused. medicare doesn’t provide the G6 yet, so what are we talking about? that u are paying for the G6 and want medicare to just pay for strips?

edit. yeah, “limbo land” is what it sounds like

When I read through Dexcom Medicare approval, the bottom line was that Dexcom needed to be able to supply a complete monthly package to Medicare patients which include the Sensors, Test Strips, and lancets. There is also a starter package they need to be able to ship. Until Dexcom can do that, Medicare will not allow reimbursement to Dexcom for any part of the bundle such as test strips. So what SherryAnn is saying, I believe, is a question of semantics. She can’t get test strips through Medicare because she is on the Medicare approved G6 but Dexcom is not yet prepared to send out the G6 Medicare bundle which includes the required test strips and until Dexcom is able to ship out complete bundles, Medicare will not reimburse Dexcom for any part of the bundle.

I am on the Medicare Dexcom G5 and have no problems getting the G5 bundle or any piece of the bundle every month as Dexcom is capable of shipping out the entire bundle to Medicare patients.

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Lol, now I’m confused…

CJ, that makes TOTAL sense to me, as that is precisely how my Medicare shipments work, including it being the ONLY way that Medicare will pay for my strips–ie, they MUST come from Dexcom, in the monthly order. No more trips to Walgreens for strips as Medicare cut that off late last year. (I had been getting 150 strips from Dexcom, and then additional strips from Walgreens. Some time around Nov or so of 2018, Medicare began denying coverage for the strips not obtained thru Dexcom, so I had my doc send them an Rx for 300 strips per month and that’s how it’s been working ever since. I’m now getting less, at my choice, than 300 as I don’t need that many any longer)

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I read through the entire Approval process for the G5 instead of watching a movie on a trip to Asia and it was interesting to see the hoops a company has to go through for approval. It is available online somewhere for anyone that is really interested. The problem is that patients only understand bits and pieces of the entire process and easily get confused why they can or can’t get bits and pieces covered for example for the G6 when they can get the bits and pieces on the G5. You have been through the package process so have an easier time getting a grip on the entire government thought process.

Dave - your next set of questions will probably be. What about the states where Dexcom is not authorized for direct delivery.

So my next question is? Do you have a choice of which strips you get?

yeah, and not having to go to Walgreens as often is true blessing. Don’t get me started on the local pharmacies. We have bounced between 3 of them (Safeway, Target, Walgreens) because of horrendous service and incompetence.

No. I get the ones I want–Contour Next. IMO, the best on the market.

Nope - You will get contour next one strips exclusively.

BTW in the starter Medicare package, Dexcom also gives you all sorts of other goodies including a transmitter, receiver, contour one next meter with all its accessories, spare battery, control solution, manual and probably a few other things I have forgotten.

Lol, I have One Touch, Libre, Omnipod, Accucheck and another one I’m not thinking of at the moment, why not add another. Just not a contour yet unless it’s buried somewhere. I hate the Libre and the Omnipod the most as it takes more blood for the strip.

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Contour Next even lets u add additional blood if u didn’t get a proper amount on in the beginning. u have up to one minute to add additional blood.

page 18

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@Dave44 That’s like my dogs Alpha Trak 2. So handy especially with a dog. Nice!!!

And of all the meters I have ever used, the Contour Next uses the smallest drop of blood so it is really very rare to have to add additional blood. This is great at the hospital because when they do a finger stick there is always enough blood for their strip + my strip so that I can compare results using the same drop of blood between the hospital meter and mine.

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Thanks for all of your feedback, folks. I am not on an Advantage plan right now because I am a Snowbird with homes in two states and thus doctors in two states. Advantage, therefore, does not work. (Don’t read into that statement that I am rich. I am not. We bought our Florida home when the market was REALLY down, and we bought a fixer-upper, so we got a good price. I could not afford our southern house in today’s market.) I am very sensitive to insulin, so having a great difference in meter readings really affects my health. I cannot be without a back-up system, as I am sure YOU cannot be without one either. I have spent money out of my own pocket to get G6 supplies and now have a system to get the G6 supplies. Now I find that insurance will no longer cover the strips! So once again, I spent my own money to buy a Contour Next One meter and the strips to go with it. Once the Insulet OmniPod Dash system is released to Medicare, I will try to get on that since that system’s algorithms are tied to the Contour Next One meters. What my post was warning everyone about is that Medicare does not think strips are necessary for the G6 system; thus, even when Dexcom DOES release it later this year for Medicare coverage, Medicare still probably will not cover the “whole package” with meters and strips that some of you are talking about because Medicare does not see why G6 users ever would need test strips if no calibration is required.

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