Medicare only covers what now on test strips?

Type 1 and LADA
1

i went to my drug store to figure out why i havent gotten my test strips yet. it was because it needed the icd code. once that was submitted, medicare comes back saying it wont cover the testing of 4 times a day but only 3 times a day. now this is medicare part D… um, type ones test more than that and medicare wont cover supplies unless you are testing 4 or more times a day. so what is the deal? so i have a prescription going in for 3 times a day so im able to get my test strips which ive been out of for a few weeks now and been using my backup. im going to call my ins and find out why they only cover for type 2’s checking vs type 1s. are there any other type ones that only cehck 3 times a day? anyone else have this issue? what did you do about it, etc

has anyone else have a problem? what did they do to get them to cover

2

shouldn’t be part D. Should be Part B. a doctor’s Rx will get u as many as u can prove thru testing logs/downloads of meter reports that you are using an average of what you are requesting. I currently can get 300 per month and used to get a LOT more, thru Medicare for the last 3 years.
I Know if you want a pump on Medicare you must prove u are testing a minimum of 4 times per day OR are using a CGM. Logs are required! I just went thru that TODAY as I’m getting my first pump thru Medicare…

FYI, if you Google for info you will see a lot of misinformation about quantities, such as “up to 100 strips per month”. that is patently false.

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3

yes part b…sorry…my brain glitched for a second so yes part b. i still should call them and find out what they need to prove that i test more than 3 times a day. so logs, etc would work? pump supplies i have no issues as long as i see my endo every 3 months and every once in a while to prove i test 4 times a day.

4

I am on a pump and I am covered by a Medicare Advantage Plan.I get 150 strips per month through part B at no cost.

5

how many times a day does that last you? im trying to figure out what to say to them tomorrow

6

YOU have to have a log!! You don’t get to just make up a number. I explained that earlier. I’ve been doing this stuff for the last 3 years, for Medicare.

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7

If you use Libre you get no strips - period

8

i use the dexcom. its been a lifesaver for me in knowing where i am about. i still get my supplies tho.

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9

In that case you need to have the prescription for your test strips sent to Dexcom and they have to be for contour next strips as that is the approved calibration meter that Dexcom uses. Then you can get as many strips as you can use.

10

Dexcom gives you 150 strips a month, unless you ask your doctor to write a prescription for more strips. Dexcom will send you the meter free of charge. The contour next line of meters are the most accurate on the market.

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11

hey. that sounds like I wrote it. Dead-on accurate on all 3 counts.

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12

Hard to argue with facts and the truth. They’ll still try🤪

13

I heard the same change was coming for Dexcom G6.
Forgot where I heard it.
But I think it is related to not being required to calibrate.
Whatever the rule is for Libre would have to be applied equally to Dexcom.

I assume there is always an appeal process.

14

There is always a doctor ready to write a prescription if and when needed.

15

But what about the asterisk ?

*If your glucose alerts and readings from the G6 do not match symptoms or expectations, use a blood glucose meter to make diabetes treatment decisions.

16

Abbott has the asterisk also. (quotes below from Abbott’s FreeStyle Libre website)

If Dexcom does start shipping G6 to Medicare recipients in Q4 then we will know for sure.

I think it would be problematic for CMS to apply their rules differently among two different companies who are competitors. Which is not to say that never happens…

  • Fingersticks are required for treatment decisions when you see Check Blood Glucose symbol, when symptoms do not match system readings, when you suspect readings may be inaccurate, or when you experience symptoms that may be due to high or low blood glucose.
17

Interesting info here.

For years, Medicare deemed CGM systems “adjunctive” because their FDA approval called for confirming blood glucose levels with a finger stick test before insulin dosing. In practice, however, as the Dexcom systems improved, users would make dosing decisions based on CGM data. A daylong hearing before an FDA panel in July 2016 prompted a new indication to allow dosing directly off the CGM, which in turn caused CMS to create the “therapeutic” category.

But the rollout wasn’t easy. Medicare DME providers initially balked at shipping the device when it didn’t come with a meter for calibrating the CGM, and Dexcom partnered with Ascensia to meet requirements for a Medicare “bundle.” Dexcom [added staff]

(Dexcom Works to Bring CGM to the Medicare Population, and More) to help Medicare beneficiaries get through the process.

18

Insurance companies can always turn down whatever prescriptions for drugs or certain items they decide they shouldn’t have to pay for. Even if you have a prescription from the doctor. Sometimes they will cover it with a an appeal, or higher copay, but sometimes they just will flat out say no. A prime example is some of the more expensive drugs for cancer.

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19

Was really excited to hear this since my company insurance won’t cover the Contour meter or strips. Unfortunately I just called Dexcom CS to set it up and they said the offer was only valid for those on Medicare.

I’m always a bit leery of what I hear from Dexcom because the move to Manilla is so recent. Has anyone with private insurance successfully capitalized on this offer?

20

They’ve included a few contour next meters with my orders over the years. I don’t have Medicare, and get my test strips at the Kaiser pharmacy. I use the contour next link which came with my last few Medtronic pumps.

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