Test Strips Covered by Health Insurance Problem

Hi Everyone! I am having a problem getting test strips covered by my health insurance and I was hoping someone might have some advice for me.

I recently switched to a new endocrinologist near my college. She is great and wrote the statement of medical necessity so that I could switch to the omnipod. My insurance did not even require a prior authorization. I had previously been using a medtronic pump and a one touch meter. My insurance always covered my test one touch test strips and I only payed a $15 copay. My insurance is covering the omnipod at 90% which is great!

So now that I am on the omnipod I wanted to use the freestyle test strips that work with it. I called the endo office and they wrote the prescription. I went to the pharmacy to pick up the strips and was told they were "non formulary" and that I needed "prior authorization" (which seemed strange to me because the pump didn't even require a prior authorization).

So I called the endo office and was told by the nurse that the pharmacy had asked for the prior authorization already and that it was "in process". This info was garnered on friday. So I let it go for the weekend.

Now today I received a voicemail from the endo office nurse telling me that they needed prior authorization for the freestyle test strips (which I already knew). She then asked if I could call the health insurance and ask them which strips and meter they do cover so they could prescribe those strips.

Switching to a meter with covered strips does not solve the problem. I want to use the strips that work with my omnipod and I don't get why the insurance company wouldn't cover the strips to work with the pump that they cover at 90%!

How do you folks think I should proceed? Btw I have Empire Blue Cross Blue Shield if that makes a difference.

Just make sure the nurse understands that your pump requires the freestyle strips and have her write a letter to that effect. That’s really the best that you can do… And they may just say no because the omnipod doesn’t actually require freestyle strips (I don’t think) it’s just designed to be most convenient with it… I’m sure a lot of members here have had this same battle with freestyle strips for omnipod though so hopefully someone can be more helpful than me…

Thanks Sam! I am going to call today and ask them to write the note. Hopefully I can get some coverage for the freestyle strips. It really will make management much easier to test with the PDM I think.

I agree with Sam that a letter from your doctor might do the trick. The letter should explain that the Freestyle meter is a built-in component of the Omnipod insulin infusion pump system. This feature is important as it enables correct and safe dosing of insulin.

Good luck. This is frustrating as good diabetes control is a delicate balancing act with the biggest influence, the person with diabetes themselves. Your opinion should matter. Instead we're faced with a limited menu of options determined by business-type bean counters.

Btw this is one more example of why I refuse to do business with one touch / lifescan. As far as I’m concerned their entire business model is to develop a mediocre product and then force everyone to buy it by making it the only preferred brand their insurance will cover— I actually pay more to get a no-name generic brand instead just on principle (and because they work better than one touch)