This week I made a big achievement. I managed to persuade my doctor to prescribe me 600 strips for the next 3 months. As background, what normally happens is I get 400, then I beg for more. Usually getting to 500 is not a problem, and after that things get difficult. Either I get more or I get samples. And usually at the beginning of the next 'quarter' I end up buying strips and bringing the prescription later. Buying them in this quarter and getting the prescription next quarter seems to work as well, but that's just kicking the can down the road of course. It's all a lot of effort (trips or phone calls to the doctor and trips to the chemist) and even at times anguish (to test or not to test, that is the question). Last 'quarter' (quarters are very, very important in the German health care system) despite many kind donations of samples, I still ran out. I was abroad, and the chemist didn't have any strips for either of the meters I had with me (two meters equals more samples, you know...) to sell, so instead I ended up with yet another meter, which came with 10 strips. Enough to get me through.
The joke of it is, I'd be happy to pay for some of these strips. It's (to some extent) my choice to lead an active life full of changing schedules and biking (I don't have a car). And if I had a car, I expect I'd want to check on the sugars often too. I don't recognise hypos as well as I used to. The answer however is always no, no you don't have to buy them, you shouldn't buy them, and so on. And yet the same doctor has so much difficulty writing the prescription to solve the problem. Why?
There are two reasons. One is that doctors are scared of the insurances claiming that the prescription is over the allowance per (you guessed it) quarter. The diabetic must be throwing the strips down the toilet, using them to build interesting architectural models or perhaps selling them on eBay. Why should they pay for them? So the doctor has to pay. The thing is, so long as there is some medical reason for the diabetic needing the greater than 'normal' number of strips, this can, according to my reading, basically not happen. There is no legal framework for limiting the number of strips.
The bigger problem is the more general one of prescriptions and budgets. Doctors can be punished heavily for exceeding a certain prescription budget. As far as I know they don't even know how much they have - if an insurance decides they are being flashy with those pink scripts, they can be charged thousands upon thousands of euros. And I imagine that the problem above could play into that problem too. Who knows.
Ridiculous? Yes. Doctors serving areas with large numbers of elderly, more often sick, people are especially vulnerable. And I imagine insurances with disproportionately more older people are especially vicious. I could go on to discuss Germany's system of many, many, practically identical, non-commercial insurance companies, but it wouldn't end well.
So why did I get my strips this time, all in one go? I'm not entirely sure. Part of it was by being annoying, and I feel bad about that. I regurgitated a report from the internet about a method to get the insurance to cover the strips directly, independent of the doctor's budget. The doctor claimed this was nonsense. What may have cracked it was something that isn't nonsense: the more strips on one prescription, the less the insurance pays. There are various brackets of numbers and the price goes down accordingly for buying in bulk.
Here's hoping 2015 is the year of CGM being accepted as a partial replacement for stick testing, bringing an end to the monopoly of the test strip companies (when you see the prices across brands, you might be tempted to call it a cartel) and an end to petty fighting between patients, doctors and insurances for something that is desperately important for diabetes control, knowing what your blood sugar actually is and some indication of how it got there and where it's going.