FUDiabetes

Medicare did what now? test strips issue

i went to my drug store to figure out why i havent gotten my test strips yet. it was because it needed the icd code. once that was submitted, medicare comes back saying it wont cover the testing of 4 times a day but only 3 times a day. now this is medicare part D… um, type ones test more than that and medicare wont cover supplies unless you are testing 4 or more times a day. so what is the deal? so i have a prescription going in for 3 times a day so im able to get my test strips which ive been out of for a few weeks now and been using my backup. im going to call my ins and find out why they only cover for type 2’s checking vs type 1s. are there any other type ones that only cehck 3 times a day? anyone else have this issue? what did you do about it, etc

has anyone else have a problem? what did they do to get them to cover

Did you have RX from doctor to prescribe testing 4 times per day?

Is this a recent change, or did you get 4x last fill?

yup the dr has it on there and the medicare still wont cover it. they only cover 3 times a day checking. i got the 4 or more time last time. so this must be a recent change that no one bothered to tell me about. you figured they would send you something in the mail to let you know that there is a change, etc

Check this article. Looks like it is CVS only new policy, and with additional DR notes on RX still not cover it. So go to Walgreens.

https://www.physicianspractice.com/article/physician-outrage-over-cvs’-new-diabetic-testing-policy

From article:

However, I learned from several local CVS pharmacies and endocrinologists in other states that CVS as a company has decided it will not dispense more than Medicare’s basic allowance, one if on pills and three if on insulin. I was told that is all they will dispense regardless of what a physician prescribes or any circumstances that may justify more frequent testing.

im able to get my metformin and insulin ok…its just my test strips has changed. i think i may need to give them the log that shows how many times a day i check, etc…interesting article. it sounds like medicare is giving cvs the problem from my understanding. i cant go to walgreens as they arent open 24 hours and they messed up my prescription orders so many times i the past. one was my anti seizure meds. i needed them filled and the person told me we will fill it when we get them, blah blah blah. i asked when that will be and he said he didnt know, blah blah blah. so i can only go to a cvs. i am determined to get cvs to cover the ones i use. i never had an issue in the past

I think Medicare causes problem by setting default max to 3/day. MC allows more with dr notes and BG logs. But appears even with that,CVS may still only do 3/day based on other discussions.

Do you have dexcom? Some get bg strips bundled with dexcom sensors orders, but only Contour next brand (which is good meter) up to 150 per month.

im determined to get what i need. i may need to get the logs sent to medicare. not sure how as im waiting for the drug store to get back to me about the current prescriptions and i can work on getting medicare to cover more once i get this script as i need to have some before my back up meter test strips run out. and yes i am on the dexcom. i may see if the medical supplier i use can do the test strips. if they can i may switch out and get them through them. then its one less prescriptions to get filled at the drug store and i can concentrate on my pills that i take.

Good luck. I think CVS will want to see log and notes from your doctor. And probably still won’t, but give it a try. Hopefully quick turnaround for dr notes.

i hope it will turn around…i think i need to call medicare first and find out whats going on, on their end to see what is needed, etc

i am on Medicare for years, and they have always honored a 10X/day amount of test strips. this is just a deal that CVS made with Medicare and has nothing to do with many of the other available pharmacies. you are not the only one having this problem; you are not alone and dont fret.

just have your endo or pc call in at Walgreens/Duane Reed for the 10/day. you’ll be fine. you dont need to give them any test logs either. just your RX from your doctor. currently i get 300 strips per month. i test about 20/day and pay OOP for the rest of my strips, which is $$$, so i take everything i can get through Medicare :rofl:

i just may have to ask the company i deal with my cgm and pump supplies and see if they do test strips.if they do i may go through them to get them

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i think that’s a great idea. in the past i have also gotten my strips through CCS Medical who provide all of my pump supplies as well as my sensor supplies. if you havent tried CCS, its worth it (if you are dissatisfied with your current company).

(800-617-6671) main number. hope this helps you out.

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i have tried ccs…i had trouble getting supplies from them as it was a hassle. they had certain rules, etc. i have a local company that i get my cgm and pump supplies from. they do test strips so i message them to see if they do my test strips. if so, ill start getting them through them. just need my dr to submit the script and everything.

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just curious: what kind of rules did they have? i’ve been using them for 18 years and never had a glitch.do you think it was bc of your insurance? are you also on Medicare or private insurnace?

I’m sorry this has happened @amymc. What a frustrating experience!

I think your plan to call both Medicare and the pharmacy is smart. Don’t back down. Stick to what you need. Also get your doctor on board to help for this! They can write an RX, but they probably need to ensure that it’s written correctly. We’ve had issues with that in the past.

Also Costco pharmacists are excellent in every state where I’ve used them. You do NOT need to be a member for the pharmacy. I’d suggest trying a Costco if it’s at all possible. However in our town Costco will only do the pills and insulin and afrezza part and my mom has to go to Vons for Medicare part D. We have had better luck with Vons, walgreens in our area it was ridiculous for Medicare part D, and so was CVS.

Additionally, does anybody else know if Medicare part D covers type one diabetic test strips? Do you think those could be covered under Part B because of T1? This article makes it seem to me it is possible:

in order to get your supplies you need to see your endo every 3 months or they wont send it and you need proof that yu went, etc. i have medicare and medicaid or in my state medicaid is called masshealth. that what i have for insurance. i also had delayed in sending my supplies. i may give them a try again.

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i also do not know why it isnt going towards my medicaid to get paid. i know prrimary gets biled first then the secondary goes next. i use to be a medical biller but not for prescriptions. it was more of collecting copays, calling ins companies for prior authorizations and referrals, and to see if ins is valid, etc. but i know a lot on how it works too.

i never thought to use costco. there really isnt one near me. i would have to see where is the nearest one to me. im going to call medicare on monday as its too late for me to call conidering i just woke up and i need to do a few things before i do any phone calls. first time ill be calling medicare since i gotten it in 2015.

i go through this, too. after every endo visit, i set up my next one so that they are always 3 months (or a little less) apart. at least this is the ritual with Medicare.

my issue is my endo is popular. so he may not have something every three months but we shoot for it. im usually one month off if we cant make it. i see him again next in oct which makes it three months since i saw him last which was july 24th, etc. and i like my endo. been his patient since 2009.

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my endo is very popular too, which is why i make the next appointment right before i leave the current one.

very important info to know for Medicare: you do not have to see the endo, just anyone in his office, like your cde. they just need a record that you have been to his/her office within 3 months. (this has happened to me once in the past, and CCS/Medicare would not send me my supplies until i had proof that i had been to the office.)i know that it is much easier to get an appointment with your cde than it might be for your endo. just FYI for the future. i hope that this info helps some. i know it can really stink when you’re up the river without a paddle :grimacing: