Who doesn’t sometimes need help navigating life with diabetes? That’s why we offer Ask D’Mine, our weekly advice column, hosted by ve
teran type 1, diabetes author and educator Wil Dubois. This week, he takes a look at the federal government’s involvement in approving test strip prescriptions, and — being an expert continuous glucose monitor user and book author on the topic — Wil gives some advice on what sometimes happens when a GCM transmitter stops working. Go on, read up!
{Got your own questions? Email us at AskDMine@diabetesmine.com}
Nancy, type 2 from Missouri, writes: When I picked up my test strips this month, my pharmacist told me that Medicare is requiring my pharmacy to have a copy of my blood sugar logs for 30 days, no more than 6 months old. An annoyance to be sure, since I tend to suck at writing them down. But, beyond that, I don’t get the rationale. Is it some kind of test to prove that I use the damn strips? If so, what’s stopping me from making up the numbers for a log? And it’s feeling like a big fat invasion of privacy. I like my pharmacist, he’s a great guy. But he doesn’t make treatment decisions such as how much insulin I use or whether I’m in good enough control, so there’s no reason that I can see that he needs to have my test logs. Perhaps Medicare is trying to make it annoying for me to get the strips so I’ll just pay for them myself? Do you know anything about this?
Wil@Ask D’Mine answers: I checked with some folks in the Medicare supply biz, and they tell me that Medicare only requires the 30 days of less-than-half-year-old data when a patient uses more strips than Medicare likes to pay for. As a reminder to everyone, Medicare guidelines only cover one strip per day for folks on pills and three per day for insulin shooters. Not enough in either case.
Of course, your doc can fill out the paperwork for an “over-utilization” request. If your doc has a documentable medical reason for your needing the amount of strips that any sane person would realize that any healthy diabetic would need in the first place, the feds are pretty good about covering them. Commercial insurance is another matter altogether, however. They take the fed guidelines and cast them in stone. Getting what you need from a commercial plan is a nightmare. Cost is always excessive and sometimes even then, you’re screwed as they won’t always listen to a physician’s override prescription all in the name of “medical necessity.” So much for this being between you and your doc …
But back to your situation. Yeah, the feds do require the supplier or pharmacy to keep copies of logs or doctor’s notes. It’s nothing super-new; it’s a small part of 2010’s Improper Payments Act. And yes, it’s absolutely a test to prove that you use the damn strips. An annoyance? Perhaps. But I gotta say, if Medicare is willing to give you twice or three times the number of strips that they misguidedly think you need—at no additional cost to you—I don’t think it’s outrageous for them to ask for occasional proof that you’re actually using them.
Wow. Never thought I’d see the day I’d be defending Medicare. But will Medicare even look at your logs? Probably not. Medicare has a small SWAT team of medical reviewers that travel around the country and pounce unexpectedly on the suppliers cashing those big checks from the government. God help the pharmacy that sells you a gazillion strips, then gets raided during a random audit and can’t prove that your doc ordered the strips, and that you’re using them.
The feds aren’t going to judge your blood sugar, they’re only interested in whether or not you’re actually using what they pay for. It’s not about your health. It’s about the money. So you aren’t being judged, nor is your doctor. It’s an anti-fraud kinda thing. Medicare is served by a legion of for-profit companies that get rich preying on seniors. Late night ads, aggressive phone marketing, and refill increases that neither doctors nor patients asked for or needed got us where we are today.
Now for you, Nancy, I have a few ideas. The log doesn’t have to be hand-written. You can give the pharmacy a download of your meter—although I admit it is odd they asked you directly; typically they’d send a request to your doc. Anyway, if you don’t know how to do a download, ask someone at your doctor’s office for help. As to your privacy: yeah, the boys at the one-hour photo will absolutely look at your naked pics, and probably make copies for themselves, too. But I doubt your pharmacist is the blood sugar equivalent of a dirty old man. He’ll probably put your log into a file cabinet without looking at it. Still, if you want to keep your blood sugar data more private (I understand), you can just have the statistics page for 30 days printed. The stats page gives the number of times you tested in the time period, the highest reading, the lowest reading, and the average. Is someone still peeking into your underwear drawer? Yes, but they’ll be learning a lot less than they could from the full log book.
Could you forge a log? Sure. Why not? Teenagers do it every day. Usually in the waiting room at the endo’s office. You could even ask for more strips, forge a bigger log book, then sell the strips on Ebay. The system isn’t perfect. But the feds are more interested in keeping the suppliers honest than in keeping the patients honest.
One last thing. My friendly local EdgePark rep, one of the ones I queried about this issue, was mortified that you were turned away by your pharmacy, saying, “The pharmacy should not have refused the script, but should have at least filled the Medicare guideline amount, then required the patient to give them a log book,” before filling the rest of the script.
Anyway, moving forward, I think we’ll see a lot more requirements like this. Healthcare costs are out of control and there’s going to be a lot of time and money wasted to ensure that we’re not wasting time and money. But for me, I would have been more than happy to give my insurance company two log sheets per year to get the strips I need. I gave them a lot more than that, and was still turned down.
Allison, type 1 from Arizona, writes: OK, I need to get my Medtronic sensor going again. I have your CGM book in one hand and
the little blue transmitter charger in the other. I’m trying to figure out why my charger is flashing red. I’ve changed the battery and even left it plugged in overnight. Suggestions?
Wil@Ask D’Mine answers: Sorry Allison, you’re screwed. Red is dead. A little-known, but apparently published (in small print, in Appendix MCXII of the MiniLink user’s guide) fact is that if you let your transmitter fully discharge, it’s the same as drowning a baby squirrel: There’s no bringing it back.
You’ll have to buy a new one. If it makes you feel any better, I did the same thing to an iPro transmitter at the clinic. My boss told me if I ever did it again, it was coming out of my paycheck!
So here’s the deal, boys and girls: If you’re taking a CGM vacation, put a fresh copper-top into the little blue charger and leave the frickin’ transmitter plugged in. If you’re on a CGM vacation and didn’t do this, go attend to it right now.
No more drowned baby squirrels! It’s crazy because we’re “trained” to worry about over-charging batteries on our devices, but not warned that apparently, keeping a trickle charge going to your Med-T transmitter is its life support system. I guess taking our squirrel analogy to its extreme, keeping the transmitter charging is needed for healthy hibernation.
Disclaimer: This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.
“Medicare guidelines only cover one strip per day for folks on pills and three per day for insulin shooters.”
So, as a type 2 I’m guessing Medicare does not see the necessity of my using more than one strip per day, although I am on humulin r and lantus as well as metformin? Because they aren’t paying for more than their one box of strips per month, when I need extra it’s out of pocket.
you just contradicted yourself.
Not a contradiction, just not clear. I’m one of the people that medicare wants the data that Wil says is for “when a patient uses more strips than Medicare likes to pay for.” So, if I’m using 3 strips per day and they think that’s too much, I’m guessing they think I should be using at the oral med rate of 1 strip per day. During the summer, when I was learning the ropes of short-acting insulin, I was using at least 8 strips per day and everything over 3 was out of pocket. I can sort of predict what my blood sugar will do now but I still think that 3 strips per day is a stupid limit.
>> nancy: “I still think that 3 strips per day is a stupid limit”
I couldn’t agree more…it’s actually beyond stupid, totally inexplicable!
Medicare’s T1 strip limit of 3/day (without onerous and intrusive supporting documentation by caregivers and patients alike) belies having ANY basis or relationship to either consensus medical practice or patient needs!
Our achieving sufficient control to hopefully ward off dire complications such as amputations, kidney transplants, blindness, dialysis…ad nauseam may rarely involve ONLY 3 pre-meal tests – on a good day – but typically require 4 or 5 per day, and may on a bad day need 6-8 tests due to such common events as verifying a suspect reading, hypo & hyperglycemic events, postprandial testing needs, pre-driving safety checks, during or post exercise checks, cgm calibration tests, and more. A reasonable limit should be stated in terms of tests per month (NOT per day) in order to adequately address the actual ranges involved in per day testing…e.g. 150 strips per month for insulin dependent diabetics.
While structuring benefits to support the public’s medical need understandably must also address minimizing potentials for ‘waste, fraud and abuse,’ there certainly must be better ways to do the latter than by compromising the main objective and thus greatly risking incurring huge medical costs to the taxpayers for treating increased expensive complications down the road. A prime example of “penny wise, pound foolish!”
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Wil: So far I’ve been unsuccessful in my efforts to identify who (if any) medical professionals were party to Medicare’s (Congress’s?) structuring of their poorly thought out test strip limits. Do you know or have sources who may be able to answer the question? Also, any thoughts on how we can individually or collectively get this issue addressed and corrected by whoever’s responsible for it? ADA and JDRF type organizations should be leading the effort…but oddly haven’t done so that I’m aware of.
Coincidently, this month’s issue of “Diabetes Forecast” talks about this. See pp. 38-40.
I still don’t understand, in any case, why insurance providers don’t cover more strips. In my thinking more strips = better awareness = better control = less complications.
There is a meter out there from Precision, I think it’s the that can do both glucose and keotnes. It is a different strip for keotnes, and if I remember correctly they are pretty expensive. One of those things where if your insurance covers it, it’s probably worth it, but if not you find a way to deal without it…Hope that helps!
Insurance fraud regarding test strip acquisition also occurs when patients sell their “excess” strips in classified ads or over the internet, a practice of which I’m sure Medicare is aware. These people make it harder for all the patients who legitimately need more strips.
As a type 2, I test 5-6 times a day, and must prove to M/care that I really do. The super-smart people at my chain pharmacy came out with a great solution, tho it creates more work for me, which I did get used to.
Once a month I must mail in the testing log they sent me, which shows the times of day when I test, plus my readings.
I also keep my own log, which I show my endo, on which I also record the foods I eat. Right now I’m eating my b’fast, which is a huge salad, b/c it’s the only morning food that doesn’t significantly raise my blood sugar level.
Thanks for addressing the question about Medicare and strips. Because the evidence is mixed on the health benefits of SMBG in non-insulin users (that’s looking at populations–on an individual level, you and your doctor deciding that you need more strips and doing the proper Rx coding and any needed documentation is allowed, but does require an empowered person with diabetes, a dedicated health care provider, and some extra documentation effort as Wil notes). Medicare is going to continue to eye how to cut the vast dollars spent on diabetes–especially dollars that we can’t prove translate to direct health improvement outcomes. Here’s the link to the Diabetes Forecast buyer-beware article that reveals some of the strip fraud issues that contribute to strip costs (and, thus, indirectly, access to strips and to reliable strips) http://www.forecast.diabetes.org/strips-dec2012.
I am very disappointed in our Congress the very peolpe who’s main concern is to protect their constituents have failed the American peolpe by passing the heallth care bill without knowing what it actually contains. It is also irresponsible of them to lower medicare fees which are already to low ,it would nice however if the goverment would pay 21.3% of the Doctors overhead expenses.