I am having trouble picking up my usual 400 test strips that I get monthly for the last three years. CVS pharmacy said I needed prior authorization. My doctor said I didn’t and wrote a new RX. After two months of being told that I could only get 200 strips, I called my insurance in front of the CVS tech. who told them they would pay for 400 and I didn’t need prior auth. CVS then said that it was a problem on their part as their computer says 400 strips a month is excessive. Even though I have picked this amount up for 3 years and my doctor wrote a script for it and my insurance said they would pay. CVS had to call a corporate office to get it okayed , but said this will be a problem each month as 400 is considered excessive. I feel like I should’t have to justify why I need that amount and explain in front of a store full of customers. If my doctor thinks I need it then that should be enough. I test before driving each and every time, I had a terrible accident because of a low and I don’t want to hurt anyone. I have also had dka several times and test a lot when feeling ill. Should I just accept the 200 a month they say is not excessive?
I’m currently using about 420 strips per month. I don’t think this is excessive if you’re willing to do the test and use the numbers to make decisions about eating, exercising, and driving. Your thoughts are very rational to me.
I’ve cut and pasted this excerpt as published in the American Diabetes Association Journal Diabetes Care:
Type 1 Diabetes Through the Life Span: A Position Statement of the American Diabetes Association
Jane L. Chiang1⇑, M. Sue Kirkman2, Lori M.B. Laffel3 and Anne L. Peters4 on behalf of the Type 1 Diabetes Sourcebook Authors*
Recommendations
Patients with type 1 diabetes should perform SMBG [self monitoring of blood glucose] prior to meals and snacks, at a minimum, and at other times, including postprandially to assess insulin-to-carbohydrate ratios; at bedtime; midsleep; prior to, during, and/or after exercise; when they suspect low blood glucose; after treating low blood glucose until they have restored normoglycemia; when correcting a high blood glucose level; prior to critical tasks such as driving; and at more frequent intervals during illness or stress. (B)
Individuals with type 1 diabetes need to have unimpeded access to glucose test strips for blood glucose testing. Regardless of age, individuals may require 10 or more strips daily to monitor for hypoglycemia, assess insulin needs prior to eating, and determine if their blood glucose level is safe enough for overnight sleeping. (B)
I could easily take the above list, as written and published by diabetes experts, and show how to use 14 strips per day. I would cite this article and strongly stand up to the insurance bean counters that don’t know what the h-e-double hockey sticks they’re talking about. I find such a stance offensive.
400 strips per month is over 13 strips per day. The most my daughter used (before Dexcom) was about 8 or 9 per day, maybe up to 12 per day on a sick day. 13+ strips per day sounds a little high to me, but that’s just my opinion, and YDMV…
If you need more there are affordable cash alternatives. I personally don’t believe it’s a reasonable expectation for insurance to cover more than say 300 at the most per month (and in most cases less)… I gave up on insurance with test strips a long time ago and it’s the best decision I’ve ever made. Far higher quality products are available on the private market for the same amount my copay would be when billing them to insurance.
Thanks for your reply. The difference is I drive and I am guessing your daughter doesn’t. I test each and every time I get in a car. I had a terrible car accident due to a low and I don’t want to lose my driver’s license or hurt someone.
Thanks for your reply. I appreciate your article.
Thanks for your reply. My insurance company has no problem covering the 400 strips. It is the pharmacy that thinks it is excessive. Can I ask where I may look for test strips on the private market. I looked on ebay but they are very expensive. My copay is only 10 dollars month for test strips.
I suspect that the pharmacy is more than happy to sell anything that the insurance policy will pay for…
I buy Truetest strips on Amazon $45 for 300. They are some of the best strips on the market per consumer reports.
I would get a new pharmacy. I also use a lot of strips for the reasons you do. My insurance requires me to use mail order to cover them. I hope you get what you need lola. It’s a shame when some corporate red tape keeps us from driving or knowing how much to bolus for dinner 
If your insurance covers, then CVS shouldn’t have a say. It doesn’t matter whether or not anyone else thinks it’s excessive. That decision is up to you, your dr, & your insurance.
Do you have to use CVS? If not, I would take my business elsewhere. Hope you find a solution that works.
That’s a LOT of finger sticks. Here’s how you can get 8640 glucose tests a month COVERED by insurance -> get a Dexcom continuous glucose monitor (CGM). This gives you 288 tests a day with only 2 finger sticks to calibrate it. This has been THE game changer for me as I can adjust my insulin as often as I need. I can’t emphasize enough how critical this tool has been for managing my Livabetes. I also use the Tandem G4 insulin pump which shows the Dexcom readings on it so I don’t need to carry two devices although you can get the Dexcom receiver as a stand alone unit if you don’t use a pump.
Pre-authorization is the pharmacy’s problem. And they should only have to do this once a year when your prescription is renewed. This may well be part of a spillover problem with CVS as a corporation which has CareMark as an arm that actually manages and implements some of the “insurance functions” on behalf of insurance companies. I would suggest that you talk with pharmacist (not a tech), get a clear understanding of their problem and make sure that the pharmacy takes care of this. Whether it requires a reminder be placed on your record or your prescription they should taking care of this, it is their problem and you shouldn’t have to deal with it.
Good point! Testing before driving is likely the reason for the difference in the number of test strips you use per day compared to my daughter. I commend you on being so responsible in keeping yourself and others safe on the road. I can only hope that my daughter is as responsible in 2-1/2 years when she begins to drive. My daughter is very lucky in that her Dexcom G5 is scary-accurate, and I currently find myself nagging her to test even twice daily in order to calibrate her CGM. When the time comes, I wish I could install a device in our car that would not let her start the car unless her BG is in a safe range.
Right after my daughter’s diagnosis with Type 1 at age 11 (and before she had a CGM), she was so very diligent about testing, and usually did so an average of 11 times daily. I remember our insurance company giving us quite a bit of hassle when we asked for 300 strips per month (which was the highest number per month her endo was willing to prescribe). At her first appointment after her diagnosis/hospitalization, her then-endocrinologist asked her how many times daily she tested her BG. My daughter answered her “about 12 times a day” and I remember being shocked and appalled at her endo’s response: “That’s too much! You don’t need to do it that much; that’s a waste of test strips!” WTF was that endo thinking?!?? It’s a fight to get most kids to test often enough, and here this endo is scolding my daughter for taking good care of her Type 1. Needless to say, (and for several other reasons) we switched endos and my daughter’s current endo is a true gem who gives both my daughter and myself positive feedback and praise for all the effort we both put into her D-care.
Since I’m enjoying a test-strip tussle myself this morning… Anyone else running into this? My scrip is for 8/day, which is ample (between days when I only use 4 and days when I use 12 it ends up being fine). So I recently switched to CVS Caremark, and boy does their online interface SUCK. One of the ways it sucks is that there’s no way to get a comprehensive list of every scrip in your account. As witness the fact that the one for my ContourNext strips isn’t there, even though I KNOW everything was transferred and most of my others are in there. So yet another of the dozens of calls I’ve had to make to the support line (whole point of the system is to save on this kind of thing–first thing you get in their message tree is “Did you know you can do all this online?” No I damn well CAN’T or I wouldn’t BE here). _Any_way…
8 strips/day works out to 720 for 90 days, which is a bit less than 8 boxes. But they can’t split up boxes, so they have to sell me 8, or 800 strips. But that’s a 100 day supply @8/day, not a 90 day supply, so they can’t fill it. A pharmaceutical coverage catch-22!
Sigh. Back to my Endo to see if she can rejigger the numbers to make fit a 90 day, but of course it’s Saturday, so… Hopefully I have enough to last through getting this straightened out and the darn things to get mailed…
I just went through this with CVS/Caremark. I switched from my pump to pens and have been getting by nicely on the samples provided by my doctor. I’ve never been on pens before and I asked my doctor to prescribe 6 pens for both short and long acting insulins to constitute a 90-day supply. Little did I know that the unit of issue was not each but a pack of five. I needed six pens, five was not enough. So I requested that my endo prescribe 10 pens for each insulin type and adjust her “take x units per day” to “take x + 13 units per day.”
Long story short, I spent countless hours with their customer service staff who don’t, I think deliberately, have a full view of the order process. As much as I tried to be diplomatic with CVS/Caremark and dutifully polite with the medical assistant at my doctor’s office, I think I wore all of their patience thin. I’ve spent no less than 5-6 hours of my time getting this order right. Not to mention the cumulative time my doctor’s office spent getting this order filled.
I’m starting to think that a certain level of poor communication and customer service incompetence is purposefully designed into the system. Delay works to the benefit of insurer and their corporate client.
The silver lining for all this frustration is that due to their packaging design, I get four pens extra every 90 days - for both insulin types. I didn’t want that or try to manipulate the system to my advantage. I’m hoping that Rx fill for the rest of the year goes without a hitch.
What’s the problem with it being a 100 day supply? They just post that it’s eligible for refill after 100 days instead of 90? I’m still learning the ropes with cvs Caremark too but I don’t understand the problem on this one.
They calculate the date a refill should be necessary based on your prescribed dosage I believe… So your “90 day supply” might not be refillable for 125 days if it’s packaged in a different quantity then exactly what’s prescribed for 90 days… At least that’s how cvs Caremark appears to be working for me
My doctor bumped up the daily prescribed dose to equal a 90-supply of 10 pens. You could be right; I’m new to CVS/Caremark. I also realize that there is no universal CVS/Caremark policy. It varies across many “flavors” of contracts. We’ll see. For now I’m happy; I have my 10 Tresiba pens in hand and my 10 Apidra pens wait for me at the Post Office.
I think the bottom line with mail order is to hair ask your doctor to prescribe significantly more than you actually need-- mine was more than willing to… I think as long as they understand that the patient knows what they’re doing and aren’t going to just blindly follow the instructions on the bottle then most good doctors should be willing to do so
That’s basically what I have to do, yes. I seem to recall doing it before with these when I was using RiteAid. Make the dosage fit how many they put in a box–that’s how medicine should work! Anyway, I have no idea why they treat 90 days as a sacred boundary that must not be transgressed, vs just calling it 100. These are Mysteries of the Holy Bureaucracy and it is not for us lowly patients to question. All ye need know is that to traduce them is to risk eternal damnation or worse. Apparently.