Medicare No Longer Covers Test Strips for G6 Users

Type 1 and LADA
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This discussion has gone round and round as to what is DME and what should be covered under Medicare. (Note: the key word is “should be” covered, not what IS covered.) Please let me give you a little history and comment about the logic of Medicare…

I am on the OmniPod, which is a non-tubed pump. Medicare does not considered a non-tubed pump an insulin pump; therefore, Medicare says that the OmniPod is not DME. Others have taken this pump designation issue to court with no success. Since Medicare says my OmniPod is not DME, both insulin and the OmniPod pump supplies must go through Part D (not B) of my drug plan. Thus, my out-of-pocket costs for insulin per year are $416, and my out-of-pocket costs for the OmniPod pump supplies are $2,150 per year. Other tubed pumps and supplies are considered Part B and are covered, but apparently the non-tubed, insulin-delivering device I have used for the past 10 years to keep me alive is not an insulin pump.

Mama B1 wrote, “Medicare Part B covers durable medical equipment. For diabetics, that’s things like insulin pumps and CGMs, plus the supplies necessary for using that equipment. In the case of the insulin pump, as long as your dr. submits a statement of medical necessity, insulin is also covered as supplies for the pump. It seems to me, in light of that, that test strips should also be covered. Think of glacial pace of most Medicare changes. The G6 hasn’t been around THAT long. I would be astonished to learn that Medicare had made that big a change in coverage for one brand of one kind of DME.”

I agree with your logic as stated above, but prepare yourself to be astonished because Medicare HAS made the change to exclude coverage of test strips for G6 users. When I first started the G6 in January 2019, my first order of test strips was covered through my corporate drug plan at a pharmacy. No problem. On March 1, 2019, I went on Medicare. All blood stick orders since then have been rejected by Medicare under Part B. Dexcom will not send test strips to G6 users under Medicare since Medicare will not reimburse Dexcom for the strips. This is purely a financial decision. Medicare says that they are told by Dexcom that the G6 does not need calibration, thus no test strips are required.

As I stated earlier, anyone who has a G6 manual in his or her hands will find numerous places where the manual instructs the user to take a blood test. Section 4.1 is entitled, “When to Use Meter Instead of G6.” It advises that when the G6 gives no number, no arrow or does not match symptoms, to use a finger stick test strip and meter. The section ends with their mantra: “WHEN IN DOUBT, GET YOUR METER OUT.” Section 4.4 Treatment Decisions reiterates that if your symptoms don’t match the Dexcom readings, you should “take a finger stick. If your meter value matches your symptoms, use it for treatment decisions. Then consider calibrating your G6 to align it to your meter. You don’t have to calibrate, but you can.” Later, in Appendix A.4, the manual gives a whole graphic section on how to calibrate the G6 meter – even though they claim that the G6 does not need calibration. If that were true, then why include a section on how to do what does not need to be done?

I have had two different endocrinologists send in Exception Letters so that Medicare will cover test strips with the G6. The first was denied. The second is in transit, but my new Endo told me outright that they have had other G6 patients’ requests for strips denied, so I should not be too hopeful.

I understand that Dexcom is in the process of changing over all Medicare G5 users to the G6. The bottom line is this: Medicare will neither provide nor cover the cost of test strips under Part B or Part D for G6 users.

And Spock is right. Medicare is most illogical.

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Thanks for the explanation, SherryAnn. The extra detail helps me understand a lot of things that I wish I didn’t have to understand.

My first experience with an insulin pump was the Omnipod. I had to change over to a Medtronic pump in mid-December, before I aged over into Medicare, because I didn’t find out until then that Insulet didn’t at the time have a Medicare contract. I asked my CDE about it when I went for my Intro to Medtronic session. Her explanation made sense, but we both thought it was stupid. Medicare doesn’t cover the Omnipod, because the part that has the insulin reservoir and injection apparatus is disposable. Never mind that the pods won’t work without the controller, which is durable. In my current pump, the plastic insulin reservoir and tubing is separate from the pump. You put the reservoir in a compartment in the pump, and the insulin is delivered through the tubing and a cannula, all of which is changed out every 3 days, and I’m certain is much cheaper than the pods. So, Medicare will cover the cheap replacement parts, but not the more expensive parts that rely on a really fantastic use of technology. [sigh]

I’m kind of surprised that Medicare is allowing one product from Dexcom to set the care standard, but not really.

I did some online shopping yesterday, and found that I can get Contour Next test strips over the counter at Walmart for around $21 a box. Since I already have a stash, and already use fewer strips than I used to, I can spring for a box of 50 every month or so. I had an Accucheck meter for years. Compared to the OTC cost of Accucheck strips, the last time I priced them ($65 and change for 50), the Contours are cheap.

I am so glad to have found this community of diabetics. Y’all are all so helpful and knowledgeable. My doctors are helpful and knowledgeable, too, but neither is also diabetic. It really makes a difference, getting help and advice from someone who’s walking the same path you are.

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I get my Dexcom CGM supplies covered under Medicare Part B from Byram and my glucose meter test strips under Part D. My Part D insurance covered my brand of strips at 100% so I didn’t argue with that. I’ve had difficulty getting strips in the past under Part B, so was happy to have my Part D insurance cover it. I suspect that Part D plans vary with their coordination with Part B policies.

I have a new Part D plan next year, same company, so I’ll have to see how they handle test strips. I test, on average 5x/day, even though I use a CGM. During the 2 hour blackout each week, I fingerpoke every 20 minutes to keep Loop happy.

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I am riding in your boat, Sherry Ann. For every reason that you listed, and then some, you need to supplement your G6 with test strips. I just started on G6 one month ago. The first sensor that I applied, gave me a reading of 129 when my BG was at 255, very high, almost 100% off. The nasty, dirty little secret about G6, is that if you try to calibrate this sensor into compliance, it takes multiple calibrations spaced 15 minutes apart, without the G6 providing anymore additional readings during this “extended calibration period.” My second and third sensors were rock solid, so much so, that my 3rd sensor performed beautifully for about 17 days. Now I’m on my 4th sensor, and that is a complete nightmare. I know from my G5 experience, Dexcom has quality control issues. When you get a good sensor, don’t remove it. Do whatever you can to extend the session. So, yes for the very basic reason that Dexcom does have quality control issues as they are ramping up their production to cover exploding demand, we need test strips. And, for those of us with Dexcom integrated with an insulin pump – i.e., T-Slim X2 – we cannot afford to operate with a hidden 30%+ error rates in the information coming from the G6. Medicare needs to address this!! I blame Dexcom for leading on the CMMS organization into believing that the G6 can totally replace finger stick testing. Shame on them!

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If u exclude the 2-hour warmup, what is your daily finger-stick average? That sounds like an awful lot (5/day)!

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Well, let’s see. The two-hour weekly warm-up uses eight strips if I include the two needed for initial calibration of the next session. So that means 5x/day average is 35/week, subtract 8 and that leaves 27. Divide by 7 days and that means about 4x/day on average excluding the warm-up period and initial cal strips.

I fingerstick every morning when I get up since I like to confirm how well my CGM is tracking. That leaves three other fingersticks as needed. But I don’t use strips evenly over time. Some days I only use one or two and other days many more. I don’t think about it much. I just test if I feel a need.

If my CGM sensor reading is stubbornly running lower or higher, like 20%, then I will fingerstick and let Apple Health pick up the reading and feed it to Loop. That helps keep Loop better informed without over-calibration of the receiver.

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My husband actually called Contour and found the same thing. The rep he spoke with said that I have three options:

  1. Buy the strips outright from a pharmacy and pay full price. While the Contour is priced less than the current Abbot strips I am using, they still are not cheap.

  2. Order the strips through the Contour.com website. There is a slight reduction in price from the pharmacy, apparently, but the price is still not great.

  3. Buy the Contour strips, as you advise above, from WalMart. Contour has a deal with WalMart that WalMart can sell them for a reduced price of $27.00 for a box of 70, but you must ask for the “rollback special” price.

Guess where I plan to buy my Contour Next One test strips? :slightly_smiling_face:

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Really? I’ve never heard of a 70-count box. Is that something special to Walmart?

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Currently out of stock but looks like normally available:

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I bought some a little while ago, and the logic behind the 70-count box was that they were selling them for the 50-strip box price. I guess they decided to continue with that promotion. As long as I can get them for a good price, I don’t care how many are in each container. :slightly_smiling_face:

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I have received the Medicare G6 Upgrade but am using up the last couple G5’s. The Dexcom rep who processed the upgrade told me that they no longer provide the test strips as they were not needed for calibrating the G6. I went over all the scenarios where they could be needed like a failed G6, etc. No doubt he had heard all my concerns before was not swayed from the party line.

So I called my Endo and had them send an Rx for test strips to my local pharmacy. Picked them up. Problem solved.

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That is precisely what I thought the solution to this new problem would be. Get them locally and covered by Medicare. Good to know it works.

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I hope that this continues to work for John and for everyone else. When I first went on the G6 about a year ago, I did the same thing. The strips were covered when the RX was new, so the first batch was paid for. Then Medicare (which is notoriously slow on reviewing paperwork) read the doctor’s report that I was on the G6, and the next time I tried to pick up the strips through the RX, the pharmacy told me that Medicare had rejected them because I was on the G6. Apparently they had not clued into that little bit of information the first time around. So John_P, I wish you well. I hope that your RX continues to work for you.

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I’ll keep that in mind. Luckily, I have a ton of strips which will last me until they are so outdated that they may lose accuracy.

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You are a wise man, Dave. Anyone who is on Medicare should do all he or she can to have a “stash” of strips, pump supplies or syringes, insulin, and whatever other drugs they need. Medicare does NOT move quickly on anything, and natural disasters like snow, floods, tornadoes, hurricanes, and fires can slow or even stop expected deliveries of goods at any time. I, too, have a stash to keep me safe and well-supplied. And yes, now I just need to keep an eye on those expiration dates.

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@SherryAnn – When Medicare finally turned down your test strip coverage due to your G6 use, was the Medicare claim that triggered that submitted under the Part B benefit (DME coverage) or the Part D prescription benefit? Thanks.

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The denial was under Part B. As soon as the doctor’s notes reached Medicare that I was on the G6, the RX for the test strips was rejected. Our Part D drug plan does not cover test strips, so it has to go through Part B for us.

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Sorry about that. I knew they were going to pull this bs when dexcom was approved for dosing etc., it should never have been approved for that I will never go without finger sticks, dex is way too inaccurate on a very regular basis for me. I guess eventually I will have to fight this. maybe a letter of medical necessity will help.

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I agree that the approval of the G6 that pretends that fingersticks are not sometimes necessary has been a grave disservice to any diabetic using the G6. I expect this dumb trend in regulatory oversight to continue as new devices come to market.

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Sadly, Dave44, I agree with you. When people who have never experienced a medical condition try to govern what devices and medications are used to treat that condition, the results generally are illogical and ineffective.

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