Test strips "restricted"

1

http://www.bbc.co.uk/news/health-23514725

This is an interesting article from the UK that notes that strips there are restricted by "managers looking to save money," sometimes 2x strips/ week being allowed. This seems borderline criminal to me, a shirking of responsibility by managers there, a role which seems likely to be filled in the US by health insurers.

Each year I get a letter from my insurer stating that "you only need 4x/ day because that's what Medicare says" with no plan for alternatives. I've learned that means I have to call my doctor, have them send a "letter of medical necessity" and then they jack around with it for two weeks. Usually, this takes place at the end of an RX and the delays have put me out of pocket the last couple of years which riles me up so I call them and torture the CSRs every day for a couple of days and then they give them up.

Of course strips *are* expensive but the article also notes "Diabetes costs the NHS around £10bn annually and 80% of this spend goes on treating complications." It seems very clear from that that more strips would be the correct answer to the public health challenge, not less.

2

i am also in a country of socialised medicine, and while i was completely satisfied with the services before having a chronic condition in both spain and scotland, i am also amazed at the stupidity and short-sightedness of the ministry of health here in spain. on diagnosis i was given 6 strips a day for about two weeks and then went right down to three.

thank goodness i get back to america in the summer and xmas so that i can buy walmart cheap-o test strips, and for my mother who was a nurse, who continually sends me extra.

if i listened to what the ministry of health advised, id be following an ADA diet on only three strips a day. i wouldnt be able to exercise, have a glass of wine with dinner and am convinced i would be well on my way to complications.

getting an insulin pump here in spain seems to be a last resort. when i was first diagnosed, i had some time with a cde and one day another pwd was there learning to carb count and was new to the pump. he had the pump cuz his kidneys had been affected, after years with diabetes. it seems that public health is waiting until youre riddled with complications and then, ond only then do they think, ooh, now what do we do?

it really makes me angry too that we not only have to do this 24/7 thinking like a páncreas, but that we also have to spend our hard earned money taking care of it after public health contributions or health insurance paid monthly.

while strips would be very helpful to those of us who are educated and use the strips to gather information, up to date information/education and ideas on diet and more educated medical staff would be a real help. using the best treatments for diabetes-pumps and cgms would also make a massive difference in the lives of pwds. i can only imagine having access to those things. im glad i dont have to do this all alone and that tuD is here because if not id be listening to all their outdated advice and doing things all wrong.

i hear ya, acid.

3

That is really sad and scary. Health care administrators are making decisions that doctors should make.

4

How many years ago did Managed Care raise its ugly head in the U.S.?

5

Yes, I "eagerly" look forward to the prescription renewal dance every year. I keep wondering why the three letter pharmacy benefits manager (beginning with a C and ending with S) can't figure out that is costs everyone more to go through this dance - ugh!

6

at least you get to do a dance. to get more test strips here i would have to let myself become hypo-unaware or have numerous severe lows requiring help from other people or ambulance rides! no thanks!

7

This is sad, but unfortunately believable. It sounds like an accountant somewhere comes to the conclusion that reducing test strips to X level will save my country Y million dollars a year and people start running with it.

Kelle Miller has a recent publication, "Evidence of a Strong Association Between Frequency of Self-Monitoring of Blood Glucose and Hemoglobin A1c Levels in T1D Exchange Clinic Registry Participants." http://care.diabetesjournals.org/content/early/2013/01/29/dc12-1770.short. She analyzes over 25,000 T1DM (about half over 18 and half under 18) for BG tests per day and A1C score. Table 3 is copyrighted, but as expceted shows that for every age group there is a reduction in A1C mean with increased testing.

Anectodally, 127 participants reported 0 BG checks per day and their mean A1C was 9.6. These unlucky individuals are the ones that really need some help from other diabetics, healthcare, or their respective governments.

8

As an accountant I take offense :-). The DCCT proved not only that a lower A1c lowers the risk of complications but that intensive management including around 7 sticks a day gave the patient a much better chance of achieving that lower A1c. The DCCT was as an extremely high quality study which health insurance companies and national health services ignore while they give lip service to science based medicine. As AR said, it's almost criminal.

Maurie

9

Are you sure that the limitation of 3 stripes per day is valid for you? Insulin dependend diabetics need much more stripes: for every meal, before bed, before every use of the car, before and after sports and so forth. I would recommend to write a letter to your insurer including a statement of your doctor.

10

Hi Acidrock,

I think this limit only applies in some primary care trusts and only impacts Type 2 diabetic on metaformin and the like. With the logic behind it from many medical professionals being that Type 2 aren't on insulin and therefore don't need to test as much as it is to be controlled through diet and exercise.

I'm a Type 1, I got a free pump, free pump supplies and I use about 300 strips a month. So consider myself very fortunate. Never been challenged over my test strip use. Although I do wonder how long this will continue with after the NHS reform act has been fully implemented.

11

i am completely sure. i have asked every single time ive been to see the cde, my nurse, my gp and my endo. thems the brakes in spain. we just have socialised medicine here. i looked into health insurance here: no pre-existing conditions covered, no scrips covered. winning.

12

Maybe we need to start a petition to address the test strip problem? I don't think the test strips should be so expensive... I wonder how much it actually even costs to manufacture them? They're prolly overcharging by a very large margin. Not sure how much insurance actually pays for them in all cases. Mine are very expensive and my insurance does seem to pay a lot for them too although I get a discount till december and I hope that will continue.

13

Excellent article and comments. Restricting and limiting strips in a day and age when diabetes is exploding around the world and yet the latest experience is showing that adequate rational testing ( using results to dose and revise eating/diet revisions and add exercise) clearly are showing excellent results, lower a1c's and reduced complications.

Where has this utter dark ages, stone henge stupid and idiotic policies come from. It seens utter ridiculous.

On top of this raindance, we have governments getting and providing a massive paperwork war, control of a non restricted item worse than narcotic drugs and constant surveillance/inspection and rigid control system stealing Doctor's time and loading that would be better spent on serving patients/diabetics on things that really count.

IF the govenment simply wants to control costs and say we only re-inburse a base line amount on meter and strips and yes your doctor needs to once a year reaffirm your strip usage and daily need. A patient can go to any mail order/drug store and if he wants more or better strips; he pays more.

This contol freak show is out of order and only providing excess s&m punishment for being a diabetic and can bloody well stop. With this day and age of advanced computer systems; fraud and usage can be easily monitored and actions taken to minimize.

My special thanks to Acidrock23 for starting this thread and giving us all a opportunity to take the blunderbuss loaded with scap iron to shoot at this incredible backasswords approach to Diabetes.

14

We'll fortunately in the states we have the ACA about to implement so we will never have to worry about this.

15

Thanks for the interesting replies. I've posted my daily tally that gets to 12 tests/ day which is pretty much how I roll and have pretty decent results from that level of testing. If anyone wants to see it, I'll be happy to toss it back there.

Re: Meee's suggestion about a petition, I think that the best way to approach this may be a class action suit. I'm sure that it is probably "barred" in some manner by the contractual provisions of insurance policies, Medicare/ Medicaid arguments. I'm sure the "enemy" can trot out plenty of docs who will testify "12 strips/ day is evidence of obsessive compulsive disorder, four is plenty. Look at this stack of documents from the AMA, NHS and other leading authorities..."

I think that our arguments are very valid. DCCT substantiates that higher A1Cs are damaging and the damages of diabetes are pretty evident. We could subpoena their data as to the cost of complications and make effective arguments as to the extent of damages.

I suspect that the big kahuna would be to subpoena all of their correspondence with each other to try to prove some sort of fiendish process or collusion and go for some sort of punitive type of count after proving it. Why does a health insurer care what Medicare covers? Why does Medicare have any say in determining what's covered? It seems as if there's 1) a pretty clear conflict of interest in the "strip question" and 2) the "bad guys" rationing strips are clearly acting in opposition to scientific evidence. That's where the gravy in a case like this would be. It would be a crazy case that would be very difficult but the flip side would be that we, the plaintiffs, might not be too concerned about the $$$ we'd get and could perhaps rally together to be interested simply for the sake of changing standards. That would put most of the $$$ to the attorneys who are generally interested in that sort of case as it can be more profitable.

16

Agreed. class action suit is needed. A petition can be ignored.

My other beef is that some very large diabetes lobbyiests are strangely silent and absent from this nasty fight and sitting silent on their hands under their derriers. Even worse when you bring this up, these parties get very defensive and nasty. Their supposed to lobby on behalf of us diabetics and not boosters/apologists for screwball government policy!

17

Here is the other side of the coin... I have an Rx for 12 strips/day for 90 days. When I fill the Rx I get 9 boxes of 100 count strips. My pharmacist (and some of his staff) now know my face and name from this prescription. This part is nice as my Rx's are gotten a little faster. But, the pharmacist has told me that "he has never seen an order for stips this big" and that makes me memorable. My medtronic carelink logs usually show I test 12.1 times per day.

Based on his manerisms/actions I completely believe he thinks I am lying and/or cheating the system. Selling strips on the grey market for profit, giving them to someone else, being a drain on health care costs, etc.

I know I will be told that this is a 'perfect' place for educating a young pharmacists and you are probably right. I just really don't think he will care about whatever I say and it will start an argument because his textbook says 4 tests a day is sufficient and he knows better...

On a lighter note, I think (hope) the pharmacist was telling me a joke last week when I was filling my 3 month Rx for humalog. He handed me insulin and asked me with a straight face, "Do you have any questions about how to use your medication?" I chuckled out loud for a few seconds then told him something like, nope I've been doing it for 20+ years and have a good idea how it works.

18

Capin; like you I get strips for three months for 15 times per day. They ask if I am really using that many and that I am the only person that comes in that gets this much quantity. I can't imagine not testing this much. I tried a Dexcom but was very disatisfied with the accuracy so I quit using it. To much money for bad readings.

19

capin:

Thank you for sharing.

As a 30 year type 2 who has spent 40 years as a electronics digital computer electronics design and debug; the attitude about testing and strips is revealing of a horrible incomplete understanding how complex systems work and the need for detailed testing and equipment to do so.

A single signal source being tested once a day or less captures a tiny and many times useless picture of what happened all day and night. Trying to debug the human body that way is like using a wind sock to determine the weather, and only a point in time of instantaneous wind direction.

Nobody seems to have a clue how fast and dynamic the human system can be and the dangers for low's/death when testing so indiscrimanently and infrequently.

If there were newer better systems that were cost effective giving a more accurate picture, possibly those arguments might have some value.

Today to place arbitrary unfounded, unscientific conclusions ( and statistics are not science but math constructs usefull for looking for generalizations and optimum targets).

Unfortunately humans due to their gene makeup and variations are not constructed the same and these statistical generalisations while helping many can condem the balance to death or a life of suffering.

I am fed up with all the sophistry and refusal to approach this matter properly, ethically and ratioanally. On a matter of outright numbers, the explosion in diabetes worldwide and the inability to resolve this mess quickly and safely argues against all thses insane and stupid policies against strip usage and testing as that today is the ONLY way to monitor, control, and imrpove the situation.

The only argument I can see is that if you test and do not use those results to modify and improve diet/calorie consumption, do not use to add extra exercise to reduce numbers , dose on the insulin, get repeated data and info for your Doctor cost effectively, walk through lows and prevent damage/death).

In addition, the breath taking idea there are no fast dynamic liver events and other issues due to drugs and one can simply sit and wait and hopefully you are OK just makes me shudder and appalled and test infrequently.

Computers and our extensive data systems give sufficient data to identify who is using more strips than can be justified without putting the whole diabetic population through hades following a restrictive paperwork chase as required and used on narcotic drugs that must be controlled. Off the street, strips are completely unregulated. What well menaing individual thinks we should control diabetic test strips using a narcotics controlled drugs boosting cost, extra DOctor's time wasted, inconvenience for all and then peddled as saving costs for all diabetics while trashing their lives with yet more hasstles.

20

I have to think that the testing is the big issue and that a new approach is needed. The organizations who claim to represent us seem to be adopting the conservative stance. Whether this is derived from collusion/ kickbacks from lobbyists or is a natural "result" of the natural human aversion to sticking needles and lancets into our fingers, it's hard to say. Any collusion would be very difficult to prove however the results, the stupid letters telling me I need 4x strips/ day, etc. seem to suggest it's well within the realm of possibility, since there is no medical evidence that such a limit is not damaging.