OT: When did Medicare stop covering glucose test strips?

Edgepark called to refill my CGMs.
I usually get a package of test strips for use in checking the accuracy of the reader.
They informed me that Medicare does not cover the test strips now--WTF???!!!
I thought it was THE LAW!.
Does anybody know what is going on?
It has always covered the test strips--that go with the libre reader,
which takes strips--because probe accuracy is not always reliable.

Not sure if it's relevant or not for your situation and I don't know the Libra reader except from a quick Google search.
I while back I had a prescript for Niacor which is an immediate release Niacin. I had this prescript for about a year until my prescript insurer/provider decided that Niacor had an OTC equivalent and no longer would cover it for the $2 for 3 months, but would now sell it to me for about $240 for the three months. I believe my insurer/provider follows Medicare guidelines for prescripts and Medicare may not provide coverage for something that is available as OTC. I've gone back to buying it on Amazon as Niacin fast release for $6.

From my minimal Googling, it appears that the Libre test strips to check monitor accuracy are available OTC (if I'm looking at the correct item). Could Medicare have seen the test strips as not essential to the use of the Libre (you don't need the test strips to get a reading, like strips for a handheld monitor). Is it possible Medicare saw this as an OTC supply and took it off their list? It may depend if your coverage is through an Advantage plan or other.
Again I'm simply just guessing based on limited experience.

Not sure if there is anything to glean from this Medicare PDF. Seems to be more oriented to finger jab/droplet with a handheld monitor, but lend a hint.
https://www.medicare.gov/Pubs/pdf/11022 ... verage.pdf.

Ask them (whomever told you that the strips were no longer covered) for proof of the change and when the change happened and you want it in writing.

Then call up Medicare and ask them.

I looked and looked and looked and I can't find anything about this change anywhere.

https://www.cms.gov/Outreach-and-Educat ... E18011.pdf

https://www.medicare.gov/coverage/blood ... est-strips

chunkyfrog wrote: ↑

Mon Aug 29, 2022 11:33 am

Edgepark called to refill my CGMs.
I usually get a package of test strips for use in checking the accuracy of the reader.
They informed me that Medicare does not cover the test strips now--WTF???!!!
I thought it was THE LAW!.
Does anybody know what is going on?
It has always covered the test strips--that go with the libre reader,
which takes strips--because probe accuracy is not always reliable.

I don't know about CGMs (Continuous Glucose Monitors) but it sounds to me like you're talking about the "control solution" that is used periodically to check the meter. I would think that any/all of the supplies may require a prescription. and most all of the supplies are covered by the "supplemental" coverage plans that most of us need to have (pay for) in addition to the medicare coverage
I know that my doctor has to issue a new prescription to my pharmacy every year for my test strips (state law in my state)
I agree with the others that you need to check with your providers (medical and insurance) to se what's going on

Good Luck

Den

.

Medicare still requires coverage of blood glucose test strips. That has not changed. But your denial may be for one of the following reasons:
-It was coded wrong
-your request exceeded the number of allowable test strips (typically--and stupidly--the insurer may limit you to ONE test strip per day)
-the brand you are requesting is not (or is no longer) on the insurer's formulary.
-the provider isn't covered by your insurer.

Contact your insurance company and ask them to explain (it should also be written on the denial of coverage). If you get the runaround, appeal the denial. You should request a copy of the "Evidence of Coverage" (EOC) for your plan and it will state in there (if it's a Medicare supplemental plan or Part C advantage plan) that test strips ARE covered. You will need to point that out in your appeal. The EOC is a CONTRACT and they must follow the terms of the contract. And the law. You can also file a complaint with Medicare if you don't get anywhere.

cf:
> They informed me that Medicare does not cover test strips now

Recently I ordered test strips. My pharmacy said that it was denied by "my insurance" because I have a CGM. I have original Medicare (not an Advantage plan).

janknitz:
> your denial may be for one of the following reasons:
-It was coded wrong
-your request exceeded the number of allowable test strips
(typically--and stupidly--the insurer may limit you to ONE
test strip per day)
-the brand you are requesting is not (or is no longer) on the
insurer's formulary.
-the provider isn't covered by your insurer.

Good points. The problem the patient has is that the pharmacy _verbally_ tells you about the denial.
1) They are not the "denier." They are the middle man.
2) You have nothing in writing.

What's frustrating is that you could be exactly right. The denial may not have been exactly because you have a CGM, but because of one of the points you made.

Related matter. I use a Freestyle Libre 2 CGM. For those who don't know about them, they work for 14 days, at which point they expire (die) and have to be replaced.

One prescription is for quantity two sensors.
Two times 14 days is 28.
The pharmacy says that "my insurance" will not _accept_ a refill request until the 30th day!
And the pharmacy never has them in stock, so when they get the green light from Medicare it takes at least one more day to get them in.
So I am typically out for 3 days per month. ONE TENTH OF THE MONTH.

If people were out 1/10 of the month of their blood pressure or cholesterol prescriptions, there would be rioting in the streets.

Related to the original post:
Like any electronics, a CGM is not perfect. Not your cell phone, not your car, not your computer, and not your CGM. You need test trips to compare to the CGM's results and to calibrate it when it is wrong.

Then I need to call my endocrinologist.

What's frustrating is that you could be exactly right. The denial may not have been exactly because you have a CGM, but because of one of the points you made.

Just like DME's often get it wrong, so can the pharmacy. Chunky, you know how to deal with DME's, so apply the same principles here. Contact your insurer and find out for reals, and don't hesitate to contact Medicare and probably your state agency that regulates health insurance if the insurer says it won't cover test strips for CGM users.

My understanding is that even with a CGM you have to test with a blood glucose meter once or twice daily to make sure your CGM is calibrated and working, plus confirm high or low readings. So it makes no sense whatsoever not to cover blood glucose strips just because someone has a CGM (and more than one strip a day, too!!!). Insulin dependent diabetes is a LIFE THREATENING condition, and it's not safe to rely 100% on a CGM.

On a side note, you can buy test strips OTC (try Amazon), and if they are too expensive for your Medicare provided meter you can get another meter and test strips that are more affordable (I've been using one called Care Sens N BT, and 100 test strips are about $20--I pay out of pocket because I'm "not diabetic YET"). While you shouldn't have to pay out of pocket on Medicare and with an insulin dependent need, it still might be a good idea to have a backup.