Why does this happen every time

So, I went to the pharmacy, wondering why they hadn't refilled my test strips automatically, and they said the precription was written for 4/day. So, I went on the doctor's website to check, and saw it said "use as directed." It's so frustrating. I thought this was figured out last month.

So, I emailed my doctor:

I am having further issues with my test strips. I was able to fill it in February, but when I went back this month, they told me that it was written for 4 test strips per day. This is not what is written on Patient Fusion, where it only says "use as directed."

Please contact the pharmacy and correct it so that it reads 10 test strips/day.

As a type 1 on insulin, I test eight to twelve times per day. You mentioned in our first appointment that you were most interested in my tests before meals. I have found through my experience with diabetes that the time I really have to worry about my blood sugar is after I eat. In a typical day, my testing schedule is:

wake up
after breakfast
before lunch
after lunch
before dinner
after dinner
at around 10
before bed.

Because I eat at 6 and go to bed around midnight, I usually test twice between dinner and bed time. Because I eat directly after I get up in the morning, I seldom have a seperate test before breakfast, although I would test again if more than an hour or so ellapsed.

Those eight times are the absolute minimum that I need to do to feel comfortable with my health. I need to test before meals in order to confirm the amount of insulin I should take, allowing for any corrections. I need to test after meals in order to make sure I didn't screw things up. I can't necessarily feel lows coming on, especially if I'm doing any kind of physical activity.

Additionally, I test before exercise and every half-hour to forty minutes throughout the workout. I test when I'm in charge of small children--their safety depends on my ability to make reasoned judgements, and besides, they are a workout in themselves (depending on the activity). I test before I get behind the wheel of a car, and every forty-five minutes to an hour when I'm driving long distances. And I test if I'm feeling off.

When I'm low, I test, treat, and then test again to make sure I'm coming back up. When I'm high, I test, take a correction dose, and then test again to make sure I am coming back down.

There is no way I could maintain my health, my blood sugar, my A1C, or anything else if I don't have enough strips to monitor my blood sugar.

Last year, when the insurance company tried to restrict my test strips to 200/month (which works out to 6ish/day--not nearly enough). I was seeing *my previous endo*, and he wrote a letter of medical necessity to the insurance so that they would approve up to 300 strips/month with a prescription. As far as I'm aware, that is still in effect. I can get the test strips if you write the prescription. But it needs to be written for 10/day.

Thank you,

I just hope that this gets through her thick skull that I'm serious. And if she doesn't clear it up by the end of the week (actually, I'm thinking the end of today--tomorrow at the latest) I am going to fire her and go back to my PCP (who also thinks I test too much--sigh). I'm just sick of this. If she doesn't write my prescriptions, what's the point? It's not as though she's told me anything new in the past four months that I've been seeing her.

If I wasn't at work, I might just scream at the top of my lungs--which really isn't conducive to the feel of the library.

I felt like I was reading my own story! My endo is a bit more accepting of my want for testing so many times per day (especially when I'm exercising and testing every 20-30 minutes during the exercise as well as multiple times leading up and following the activity so I can see my trends, etc). My endo wrote the letter but there was communication disconnect between the endo's office, the pharmacy, and the insurance provider (which largely fell on the insurance provider b/c they were the ones w/ the issue; everyone else was on board). I finally was able to get my new Rx written for 15/day.
I hope you have the same end result of getting the strips that you want so that you can take care of yourself!
And great email/letter btw. Very succinct and matter-of-fact (which I think should get the point across)! Good luck!

On the plus side, she wrote back and has changed the prescription. On the minus side, I called the pharmacy and they're still showing a hold, so they have to call the insurance company and get them to release it, which brings me to a secondary rant on insurance companies in general.

THAT was exactly my problem. The insurance company was the big hold up (after my doc had sent the new forms and my pharmacy was ready and willing to give me the strips, except for the hold that was on the account).

That was a really well written letter to your doctor. I was lucky enough not to have issues the first time I had my script filled at 8x/day testing, though the PA at the endo office told me I would burn out!

My PCP and CDE said they would write scripts for however often I feel that I need to test; they were very understanding. But they also have a PCP in their clinic who has been T1 since 1952, so I think they understand better! I am anxious about switching insurances in May. :(

Glad you got it changed! Good luck dealing with insurance.. I hope you get it resolved without major issues. :(

I got the "4x/day" letter too and, after a significant delay, they approved like 400/ month, not quite the 14 I had but close enough. I think that it should be illegal for insurers to "adjust" prescriptions. It gets me hot enough to challenge the BCBS doctor to a fight in the parking lot about this stuff. I would take him apart. I think that 12-14 is an appropriate amount but it should be auto-refilled. They always gripe about the "grey market" of idiots selling their strips but it seems to me like they should go after those people, rather than people working hard to stay on top of a ghastly disease.

I'm glad you didn't have trouble with your doctor and I hope that the insurance company will get your Rx processed tomorrow. Making you wait is just ridiculous.

AR, we need to figure out how to get it through the insurance companies' mindset that the "grey market" in test strips exists because they create problems for people who shouldn't be having any problems! If they covered test strips properly, there wouldn't be a need for a grey market. They could also do a lot about putting pressure on the manufacturers to charge more reasonable prices, too!

I'm an idealist, I know. I have a very active fantasy life!

I think the grey market exists because people give up because the medical paradigm doesn't help them, they have extra strips and they can buy crack or scotch or whatever they buy with the money?

I think the key would be a study and the support of the AMA. I'm not totally unfamiliar with the thought process involved from my own former job (investigating car accidents...) and I can see how it plays out. An insurance company hires a doctor, like maybe $200-300K/ year to "sign off" that *every* patient with diabetes "gets" 4 strips/ day. Then he #$%@& off and hits the golf course. He's not a doctor, he's a stooge and doesn't know what he's talking about and deserves to have golf balls shot through his window and off his head. The manufacturer piece is a part of it too but it's the inclination to find a doctor sympathetic to a non-medical conclusion and pay him that's my big problem. I will pay him with my 9 iron. I prefer the 8 anyway so if I mess up my 9 on his head, it's no big deal. I have no problem prosecuting people selling them on ebay (look, it's a list!) but leave me the hell alone.

With regards to my insurance, my letter of necessity has to be resubmitted by my doctor EVERY YEAR. After 1 year of authorization, the letter expires and I go back to the default of 200 strips per month, as you say, not nearly enough! Maybe your insurance, like mine, requires a renewed letter of necessity each year?

That's it. I don't think the term is actually in Black's Law Dictionary or, likely, in any medical book. I presume that it must be some crap in an insurance policy, which they have made up in order to bluff people into running away from medical treatment for some sort of evil purpose. If I could conceive of any reason to test <7 times/ day (200/30=6.667...), I might be more agreeable to it but to me, that's malpractice by the insurance company who shouldn't be practicing anyway. Every January I fantasize wildly about an enormous class-action lawsuit when I deal with it overandoverandoveragain.

Well, school interferes on Monday and Tuesday, but I have a prescription in, and hopefully it's the strips. I have a 20-25 page paper due in three weeks. I don't have time for this right now.

The idiots at BCBS are the same idiots that changed the formulary from Lantus to Levemir without notifying me this January. I got a letter in March that basically said, "we're sorry 'bout that (not telling you) but do you want a coupon for Levemir good for $20 off one prescription (never mind that your co-pay for precriptions is only $10, and the coupon is only good for one use)."

Personally, I think that the people who determine standard practice (like how many strips we get per month) should be people like us, and not some random insurance or medicaid beaurocrat whose closest contact with diabetes is the letters from medical supply companies that he posts on the wall and throws darts at to determine which medical supplies he's planning on being covered this year . . .

With some hassle, I picked up my test strips and my insulin. Then, there was a diabetes education class where I picked up some tips on losing weight.
So, I'm set for now--or at least until next month when the saga begins again.