Insurance and test strips

It’s the same with me, but it’s being on Medicare that makes it this way.

When diagnosed 4 years ago with an A1c of 10.6 and T1d at age 61, my then-insurance covered me for my (Dr. requested) 6 test strips a day using a regular bg meter. I tested 4-5 times per day and had extra strips for testing/rechecking lows and highs. The freedom to check my bg as frequently as I needed helped me to lower my A1c to 6.2.

Last June I aged into Medicare and learned they only allow 3 strips per day for type 1s UNLESS you jump through a bunch of their hoops: a 30 day log EVERY 90 days proving you tested as many times per day as you are requesting, signed by you & your dr.; two dr. office visit notes stating why you need to test that much (and apparently “so she doesn’t die from a low”, “to keep her from being hospitalized with dka” and “to help her maintain a good A1c” aren’t valid enough reasons); how long you need to test (until there’s a cure, or a transplant, or until I die?); and a recent A1c, and everything has to be cafefully worded or they will reject the request.
The last time I sent a new prescription and log I averaged 5.5 strips usage a day. Medicare only approved it for 5. Since June my A1c has crept up to 7 and now when I feel I may be going low I am afraid to use a test strip for fear I’ll run out.

I have spoken with supervisors at medicare and the mail order pharmacy but Medi- “Care” doesn’t, and the pharmacy says they have to submit to m’s rules.

I know medicare fraud is a problem, but, really? I guard my supplies!

That’s is exactly what I’m talking about! It’s not like we’re testing for no reason. We literally are testing to live. It makes no sense to me. The cost of the strips is negligible compared to the cost of one hospital visit. Even after copay of any kind.
It’s not like there is a black market for test strips!! LOL. But seriously why can’t we all band together and push Medicare to approve higher numbers for test strips. If enough people write thier congressmen, would that help or would just be a waste of time?
Mary, you and I are in the same boat. I was diagnosed 4 yrs ago as well. Except when I started I was 13.7 A1C. I’ve dropped to an average of 5.7-5.9. I’m actually trying to raise it some because of nighttime lows. Trying to see if I can minimize the amount of lows during the night. I’m hoping to stop having to wake up enough to go eat. I’d rather sleep. Only getting sleep for 2 or 3 hours a night gets old real fast. I eat 4 times a day most days. I dont want to eat that much every day, but I have to or I’m up every hour eating junk. And the alarm going off and ne waking everybody up from me fumbling around getting food.

Thanks for the replies. I’m fighting the decision already. I got dr office to resend stuff after I wrote a letter to go with it.
Well see!

Most test strips can be bought over the counter, with the RX required solely for insurance purposes; so I have occasionally purchased strips in bulk off eBay. It cost me up front, but due to the quantity I got a good deal, and it may be worth it if you have to pay out of pocket for your steps, or need some while you’re fighting with insurance.
Of course be sure to check the expiration date on the ones you’re buying.

I have purchased them before as well. You migh.t have missed my point, or I didn’t make it very clear. Let me restate it.
The point I’m looking at is this: Why do we have to fight for something that is cheap but still effective? We are preached sugar control, sugar control!! Know where you are at, test as often as you need! Then the insurance company says sure test all you want, but don’t exceed more than x amount of strips. It’s ludicrious! I understand insurance fraud an all, but testing is essential to our well being. I find it absolutely infuriating that the insurance co. Thinks that by limiting test strips is effective. When the cost of one hospital visit is far greater than dozens of test strips!! This is insanity on thier part.
I have extra boxes of insulin, but god forbid if I use more than the allotted amount of test strips!!
I also find it very infuriating that I have to get approved just because the year changed, when the day before I was approved for the correct amount. This is stupidity at its finest!!
If enough people, make a big enough stink about it, we should be able to change this. It’s not like we are wasting money for no reason. Testing is kinds essential, but yet to limit the one thing we can use to help control sugar levels, creating better health for our already damaged bodies is flat out insane.

I fail to see how this limitation saves them money. I haven’t even talked about strips that don’t work!! When it takes 4 or5 just to get one reading! I know that it is far better than it ever was before. I just can’t see how this one thing can make the insurance company more money than it already makes. It’s not a nonprofit industry!

But it is the point that I have to supplement ,pay otta pocket, to have the amount of test strips inorder to use a fully approved piece of equipment. It’s thier responsibility to see that we get the proper amount of supplemental equipment to use the approved equipment. Yet we are made to feel like we’re commiting insurance fraud just to get what it takes to properly use equipment they approved!

Thanks for the reply. I do purchase if I have to. But why should I have to. I’m also on disability, it’s not like money grows on trees.

Did ins. Co. mention pre-authorization? That’s what I ran into. Pre-authorization from endo stating it was uncontrolled type 1 got my strips. As a fellow Medicare recipient also with MDG (dry), but with chemo costs of $57,000 for 4 each session I have to wonder at the overall oversight by business geniuses (obviously not employed by CMS). Good grief!

Boy yeah. The pre-authorized thing. I was pre authorized until the 10th. The Rx was to be filled on the 11th. Couldn’t fill it because it was not authorized. Had my appt been one day earlier it would have been filled. Literally one day difference!!!
With MDG (wet), I have had no issues on any medicines etc. expensive surgeries, nada. Cost for eye shots is only $10.00 / eye to me.plus copay for dr. The meds for injection are $4K / eye, dr office visit 1K, total per visit somewhere near 10K. That’s each month. MThat part wonderful. Except for needing it that is. But try and get enough test strips…Geeezzzzz.

Medicare bureaucrats need to keep their jobs. I deal with the same thing.
T1D Roger

That’s why I think if enough of us can band together, we can make them sit up and listen. And at least try to stop the insanity of thier decision.

It gets even better. I had to pick up tests strips by Rx. Could only get 100… figures right. On the outside written on the Rx strip test 4 times per day! Impossible to do so I can test for 25 days st that rate…Geezzzz…

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I have always had the same issues but recently starting using an Abbot Freestyle Libre system. Its not a real CGM but has a sensor that lasts 10 days, (soon to be 14). Under my Blue Cross, the reader cost $65, the sensors are $25/ea. It uses test strips also to calibrate occasionally. So you can check your BG a 100 times a day if you want. No strips needed. I keep about 25 strips on hand for lows and highs but only use about 2/week. Don’t know if Medicare will cover it but it sure made a huge difference for me. Better control, know how fast food and insulin works, I recommend it highly. So it’s $75/mo for the sensors but for me that is a small price for better control. My 2c.

I’m with you there! Management is the key! I have the Dexcom G5. But it requires testing/calibration 2x per day. Each calibration requires 2 tests. Hence 4 test strips per day.
It checks every 5 min and I can check anytime I want or need. Just have to have enough strips to be able to test with.
Costs for me are about the same. Technically, it would cost about $100.00 per month. But I use the sensors for two weeks and no problems, so cost drops to about $45.00 per month.
Little over a dollar a day. Plus I can share up to 5 people my readings. Have to have iPhone, but I had one anyway, so no issue there. But it allows me freedom, my wife gets the same alerts I do and if they last too long she can call/text to check on me. If I don’t respond, she knows to come home and find out what’s going on.
Just that the stupid insurance thinks controlloing amount of test strips is smart business. Saves em money! Idiots!! Let me test my butt off and keep my butt outta the hospital, dr office etc and it will be cheaper!!
It happens every year. Calendar changes and it’s time to go to war to get reapproved for what I had last year. Why?! I t makes no sense!! Either financially or medically!

Well gotta call insurance today and see if I got reapproved again. I’ll spend the next couple of days seeing if all the i’s were dotted and the t’s crossed to see if I can get reapproved.

Thanks for the reply
Charlie

Figured I’d update on this. Called BCBS about this problem and a few other issues and here’s where we’re at. Hurry up and wait. I got denied first time due to insufficient information! How in the world did that happen! I had someone at BCBS file it and ask for the strips I need etc.
So all customer service ppl are not the same as they like you to believe!
I called and spoke to a rep that has helped me in the past, with great results by the way, and he’s is working on it for me. Waiting on him to give me an update for everything as soon as he is able to get the information.
So, how about anyone else? Share your issues with absolutely necessary need supplies and insurance woes. The more we make a united stink about it. The sooner we can get it fixed.
Later
Charlie

My employer uses something called “Livongo” (www.livongo.com). It costs me absolutely nothing, and I get an unlimited number of strips plus free consultant time if I have questions or problems. You might want to look into this with your employer (if you’re working) or see if they have some type of program for individuals at a reasonable cost.

Hi @Charlie4801. I use the Dexcom G5 too, and while the initial calibration after startup requires 2 fingersticks, after that it only takes one. At least that’s how mine works. Are you seeing 2 blood drops each time you’re prompted to test?

I’m completely with you on this issue. Our son was just diagnosed a few months ago. The amount of BS we have to go through with insurance makes us go through the roof with anger. I hear my coworker, with a different medical disability, on the phone with her insurance going through it too, with every single refill. Life saving medical supplies should not be a “maybe” or a “will I get them in time?”

Insurance is a twisted, quality-of-life-monger with a disregard for humanity, if you ask me. We need it desperately yet we’re forced to be its beggars.

I use the G5 as well, I think what your seeing is that at start up it is mandatory to use 2 sticks. If you read the directions, each time you calibrate, you are not forced to use 2 finger sticks, but you should.
When you read your reports, there is an area that shows how many calibrations you use.
I’ve found that when you calibrate that it is best to do two sticks each time. Then the sensor reading is more accurate. Just be sure to do the 2cnd calibration within five minutes of each other. I usually test and get both readings at once. I enter the highest reading first then the lowest next. Sometimes I will test a third time if the numbers are really way off. Then I still use the two closest readings. It seems to work pretty well. My A1C has never been higher than 6.2, except after my first dx readings.
Try that method. I also use the personal method too. If I see a reading that makes no sense, I won’t use it… example. I have something on my finger that throws off the initial reading because I didn’t wash my hand well enough and I throw something like a 190 and I don’t feel like I’m at 190. I retest, but I always take the readings from the same finger too. I’ve found that using different fingers will throw wildly different readings. Think it has to do with circulation times. All the blood in your hand can’t change out at the same time, there is some delay.
This technology is wonderful, but we can’t forget we are flawed! We make mistakes all the time… Just think about this. In some cases, we are supposed to check our sugars when we drop. If you drop like I do, I’m not always mentally there. I’m in my own world. I’m functioning, but in no way am I at my best. I then have to test, understand the reading and make a life changing decision with my meds. What are the chances that I’m gonna make a mistake? Or choose the wrong thing to do? Greatly increased, I can say that!
But insurance in its wisdom says that I can only use 4 test strips per day to make life altering decisions. Sometimes I’m lucky if I don’t trash the kitchen trying to correct a low. I can’t tell you how many times my wife says what happened last nite. I went to the kitchen food is open trash all over and I can’t remember anything I did!
My only answer is I don’t know, I honestly don’t know why. I can guess, but I really havent got a clue what happened. Or she will be majorly pissed at something I did or said and I have no recollection of saying or doing anything “wrong” or hurtfull.
The point is this… We have to use all the signs signals and any other information we can to calibrate the “machine” to the closest reading we can to represent where we are so that we can make the best decision possible when we are relatively sane and functioning as close to “normal” as we are ever gonna be or gonna be again. I developed T1D late in life, so I suppose I know what normal is! I’ve probably had incidences all my life, but my body hid the signs very well. Still does in fact. My reg Dr went over tests with me and said what’s wrong with these tests? I could see nothing wrong with the results. He agreed and said that’s what’s wrong with them. Nothing here would make me suspect your diabetic. We clearly know you are!

Hope I’ve helped to some degree! I get long winded, but I’ve found that if you understand what your doing with as much info as you can get. You do a better job at trying to manage your life.
Charlie

This may not be ideal, but I have on occasion purchased test strips on eBay - perhaps people switch to a different meter and have leftover strups to get rid of, I don’t know. But I’ve gotten some good prices. Just be sure to check the expiration date.

Thanks for the reply. It’s not the fact that I can purchase extra strips. I can and do that. Walmart sells them. So do many drug stores. The issue as I see it is this.
Why should an insurance company have the right to limit strips! Who are they to say x number of strips per day is enough! No one knows what we need except ourselves. It should be based individually, or case by case. Once established, why do we have to get yearly reapproval to have the same amount? For example my approval ran out on January 5th one year I needed to get approval for strips on January 6th. The very next day! I was only approved for 100 strips for the next 3 months. Why in God’s name can they say or limit test strips like that. All I did was fall asleep. My situation had not changed in any way. I still needed 4 test strips to calibrate my G5 per day.
I then spent 30 days trying to get approvals for the appropriate amount. I had to spend $ 100,00 to get thru the 30 day period, for something that literally I was approved for 1 day earlier. Had the pharmacy called the day before, I would have had no issues, but that did not happen.
I was told by insurance company that it was not that important and they would get to it in due time. That is a load of B.S.,
I cannot understand the reasoning behind this. The retail cost of these strips is $2.00 each.by approving them at $8.00 per day, that stops me from having issues and not going to hospital for a severe hypoglycemic event. One trip to hospital is way more than $8.00 per day and the risk of me dying or going into a coma is way less. How can they have the right to say it’s no big deal!
That’s my point!

My understanding is that with Medicare, you have two options for strips. Part B and the prescription coverage under part D. All your doctor has to do is write a prescription for the amount you want along with a note of medical necessity. I’m not on Medicare, but have read about this issue multiple times and it works. The G5 only requires two calibrations a day. As far as I know, Medicare patients have to get their Dexcom supplies directly from Dexcom, who include 150 strips with the order each month.

Now, the not so good news. There are stories going around the forums now, from Medicare patients who were moved over to the G6. According to them, Medicare is refusing to cover strips once the patient is on the G6, which doesn’t require any calibrations. You can still get them through part D, the copay will be a lot higher.

I am switching to G6 some time in the near future. But that still doesn’t account for the lunacy that is part of the insurance providers.
Since when is it cheaper to pay for a hospital visit, around $1000.00 per day than to pay $8.00 per day for test strips!
That’s my point totally. Give out test strips like candy at $1000.00 per day! No one is gonna test 500 times a day.That is testing approximately every three minutes.
Why should they care how many times a day that someone tests. If they are not in the hospital it saves them money! It makes absolutely no sense to limit test strips for anyone at anytime. They should be free! One or two 3 day hospital stays would potentially cover tests strips for a lifetime. Given the costs of a 3 day stay one can easily spend 15 K without trying.
Why not let people test until the cows come home and keep them out of hospitals and save that money for other more serious conditions that could arise!
It’s no wonder that this is a government run program. Find the stupidest way to do things and spend money like water. Control the most ludicrst items and overcharge as much as possible to make up for the senseless spending!

How is the accuracy with Livongo and the quality of the meter? My problem with the Livongo program is that it’s being dictated that or they cut you back on strips and lancets to an insufficient quantity. It’s Insurance bullying to force a change, taking away patient choice to pick tools that work best. The Livongo meter is much larger than the Verio One Touch that my son prefers. Plus there is no research available to make an informed choice on Livongo. I don’t who the company is and it’s hard to find much data on the tools.