Medicare coverage changes Options

[Evona]

I just saw the following on Facebook and I can't say I'm very happy about it.


Integrated Diabetes Services · 212 like this
about an hour ago ·

INDUSTRY UPDATE: It looks as though some serious changes are on the horizon in the blood glucose meter industry. Medicare has announced that it is drastically cutting reimbursement for test strips starting this July. This means that many Medicare beneficiaries will either have to switch to generic meters/strips or have to cover some steep copays.

Because private health plans often follow Medicare's lead, this could have a ripple effect throughout the diabetes market. It might not be a bad idea to start stocking up on your favorite brand of strips, because they may be harder to come by in the not-too-distant future. Just some helpful advice!

[Arlene S.]

I just saw the following on Facebook and I can't say I'm very happy about it.
Integrated Diabetes Services · 212 like this
about an hour ago ·

INDUSTRY UPDATE: It looks as though some serious changes are on the horizon in the blood glucose meter industry. Medicare has announced that it is drastically cutting reimbursement for test strips starting this July. This means that many Medicare beneficiaries will either have to switch to generic meters/strips or have to cover some steep copays.

Because private health plans often follow Medicare's lead, this could have a ripple effect throughout the diabetes market. It might not be a bad idea to start stocking up on your favorite brand of strips, because they may be harder to come by in the not-too-distant future. Just some helpful advice!

I saw that same announcement in 2010. I don't really know much about competitive bidding.

[susanhs]

I just saw the following on Facebook and I can't say I'm very happy about it.
Integrated Diabetes Services · 212 like this
about an hour ago ·

INDUSTRY UPDATE: It looks as though some serious changes are on the horizon in the blood glucose meter industry. Medicare has announced that it is drastically cutting reimbursement for test strips starting this July. This means that many Medicare beneficiaries will either have to switch to generic meters/strips or have to cover some steep copays.

Because private health plans often follow Medicare's lead, this could have a ripple effect throughout the diabetes market. It might not be a bad idea to start stocking up on your favorite brand of strips, because they may be harder to come by in the not-too-distant future. Just some helpful advice!

My supply company (DEGC/CCS)told me in Dec that I wud have t switch to the newer meter by Bayer, since they would no longer cover the One Touch Ultra strips. I have some of the OneTouch strips left, but do not want to have to start co-pays for the Bayer ones. I wonder what is happening? I am on Medicare with United Hlth Care Medigap.

Is July the beginning of Medicare's new Fiscal Year???

[Arlene S.]

My supply company (DEGC/CCS)told me in Dec that I wud have t switch to the newer meter by Bayer, since they would no longer cover the One Touch Ultra strips. I have some of the OneTouch strips left, but do not want to have to start co-pays for the Bayer ones. I wonder what is happening? I am on Medicare with United Hlth Care Medigap.

Is July the beginning of Medicare's new Fiscal Year???

I have similar insurance. My Medigap is US Healthcare AARP. I have not heard anything about Medicare not covering One Touch strips. I get my strips through Medtronic and they are covered by Part B Durable Medical Equipment (DME) as opposed to Part D (Pharmacy). I do not have a copay for either One Touch or Bayer Contour Next strips. Part B pays 80% and United Healthcare pays the other 20%. Have you received the Bayer meter? I happen to like it better than the Ultra Link and until now I have been using One Touch meters for more than 20 years.

Have you checked with Medicare? Even though One Touch strips have been covered by Medicare my supplier, Optum Rx, does not carry them. Perhaps CCS will no longer carry the One Touch. (I live in NY.)

This post has been edited by Arlene S.: Feb 16 2013, 12:10 AM

[susanhs]

I have similar insurance. My Medigap is US Healthcare AARP. I have not heard anything about Medicare not covering One Touch strips. I get my strips through Medtronic and they are covered by Part B Durable Medical Equipment (DME) as opposed to Part D (Pharmacy). I do not have a copay for either One Touch or Bayer Contour Next strips. Part B pays 80% and United Healthcare pays the other 20%. Have you received the Bayer meter? I happen to like it better than the Ultra Link and until now I have been using One Touch meters for more than 20 years.

Have you checked with Medicare? Even though One Touch strips have been covered by Medicare my supplier, Optum Rx, does not carry them. Perhaps CCS will no longer carry the One Touch. (I live in NY.)

Hi, Arelene,

I have never had a copay, either for One Touch. It was CCs who sent me the new Bayer and I did try it out and it does use less blood, a good thing. It also illuminates in the dark, so it will make checking BGs easier in the movies or in the car on the way, when it is dark out, or even in the bedroom, so I don't have to turn on the light and alarm my hubby.
My supplies are covered by Part D. I am also starting to get my insulin from Part F. Up to now I had such a good Rx program through Blue Cross, I just got presciptions and insulin, through my expensive retiree program from my former job. I am using Walgreens and will see if all goes smoothly in March, when I pick up my first batch of 3 months of insulin.

Thanks for your comments.
Susan

[Arlene S.]

Hi, Arelene,

I have never had a copay, either for One Touch. It was CCs who sent me the new Bayer and I did try it out and it does use less blood, a good thing. It also illuminates in the dark, so it will make checking BGs easier in the movies or in the car on the way, when it is dark out, or even in the bedroom, so I don't have to turn on the light and alarm my hubby.
My supplies are covered by Part D. I am also starting to get my insulin from Part F. Up to now I had such a good Rx program through Blue Cross, I just got presciptions and insulin, through my expensive retiree program from my former job. I am using Walgreens and will see if all goes smoothly in March, when I pick up my first batch of 3 months of insulin.

Thanks for your comments.
Susan

Susan,

So you should not have a copay for your Bayer strips either. Part D is a prescription drug plan. I never heard of it paying for supplies. Also when I used CCS they didn't cover prescription drugs so everything I ordered (infusion sets. reservoirs, strips, tapes) was submitted as DME to my insurance company which was GHI Emblem at the time (2011). When I switched to Medicare in 2012 I started using United Healthcare's mail order company (Optum Rx) for Part D and their DME department for Part B which only includes insulin. I have Plan F but it only covers the 20% that Medicare doesn't cover. I would like to get my insulin from Walgreen's and the pharmacist told me they would try to bill Part B. Apparently they've never done it before. My three month supply was packed nicely and it was overnighted (but got delayed for a day) but the ice packs were still frozen. Still, I would prefer not to get my insulin mail order. Do you have three insurance plans?

[susanhs]

Sorry, Arlene, I wrote incorrectly that my supplies will be covered by Medicare part D. Suppllies are covered by Part B, for pumpers, and they allow (here in S. Fla) Walgreens to supply it, or I guess I could use OptumRx, but it is so hot here, I would be worried about a delayed shipment. The registration materials that came with the OptumRx had a list of pharmacies I could use. So I took my member crads to my local Wlagreens, all 3 cards (Medicare A/B, United Hlt Care part D, and Part F. I was told by the insurance agent that I would have no co-pays and that plan F would cover all that Medicar B does not, as well as most/all of part A, in case of hospitalization. I guess that makes 3 premiums we pay, so yes 3 insurance plans including Medicare.

I have Medicare A&B, new plans this year are Medicare Medigap Plan F and Drugs Part D through United Health Care. Check you enrollment welcome booklet for the RX plan or go on line or call the company to get names of pharmacies close to you. I live in a retirement area, so I was not the first one to go to the Walgreen's pharmacy to register for such service. When I get my first insulin in late Feb or early March, I will see if they can keep it straight!!!! As with all medical issues of payment and billing, there is a huge chance for someone to slow it down, get it wrong, or not know how to do it.

Susan

I forgot to mention, the new Bayer is much smaller , which means I have more room in my purse to carry snacks and normal stuff!!!

This post has been edited by susanhs: Feb 16 2013, 06:04 PM

[Arlene S.]

Sorry, Arlene, I wrote incorrectly that my supplies will be covered by Medicare part D. Suppllies are covered by Part B, for pumpers, and they allow (here in S. Fla) Walgreens to supply it, or I guess I could use OptumRx, but it is so hot here, I would be worried about a delayed shipment. The registration materials that came with the OptumRx had a list of pharmacies I could use. So I took my member crads to my local Wlagreens, all 3 cards (Medicare A/B, United Hlt Care part D, and Part F. I was told by the insurance agent that I would have no co-pays and that plan F would cover all that Medicar B does not, as well as most/all of part A, in case of hospitalization. I guess that makes 3 premiums we pay, so yes 3 insurance plans including Medicare.

I have Medicare A&B, new plans this year are Medicare Medigap Plan F and Drugs Part D through United Health Care. Check you enrollment welcome booklet for the RX plan or go on line or call the company to get names of pharmacies close to you. I live in a retirement area, so I was not the first one to go to the Walgreen's pharmacy to register for such service. When I get my first insulin in late Feb or early March, I will see if they can keep it straight!!!! As with all medical issues of payment and billing, there is a huge chance for someone to slow it down, get it wrong, or not know how to do it.

Susan

It looks like we have the same plans. There's no premium for Part A, but for Part B the premium is deducted from my SS check as is the Part D premium. I pay for the monthly Medigap (Plan F) so I also have three premiums.

When I signed up for Part D (starting in 2012) I made sure that my local pharmacy was on the plan and I keep two prescriptions with them and also any one-time use (antibiotic, dermatological stuff) I get from them. I have been using this drug store for years and we get great personal service. But I have a lot of maintenance scripts which I have filled at Optum Rx because it's so much cheaper. I asked my local pharmacist if he would bill Medicare Part B for my insulin (I always got my insulin there before 2012 when we had private insurance) and he did some research and said he could do it for strips but because insulin is covered by Part B only for pumpers it would be more difficult because he would require a license. He was delighted when I told him that I would get it mail order. Since I was the only one who made such a request and it would be expensive for him he was happy not to have to deal with it. Then late last year we got a Walgreen's nearby. Prior to that the closest Walgreen's was too far away. (Now they're opening up lots of them.) I spoke to the Walgreen's pharmacist and she said they had no experience with billing Part B for insulin but she said they would try when I need it. So I am waiting until I need it and hope they can do it. I know they already have the license. I'd be interested in hearing how the Walgreen's insulin order works out for you. My husband had prescriptions filled at Walgreen's (he has the same plans that I have) and the cost was the same as mail order cost. I am going to try Walgreen's for Synthroid because I have trouble convincing Optum Rx that I can't take the generic which they try to send me even though the script says "brand name medically necessary."

I love the new Bayer. I have two of them. One I got from Medtronic and the other I got through Medicare Part B and my Medigap.

This post has been edited by Arlene S.: Feb 16 2013, 06:34 PM

[susanhs]

It looks like we have the same plans. There's no premium for Part A, but for Part B the premium is deducted from my SS check as is the Part D premium. I pay for the monthly Medigap (Plan F) so I also have three premiums.

When I signed up for Part D (starting in 2012) I made sure that my local pharmacy was on the plan and I keep two prescriptions with them and also any one-time use (antibiotic, dermatological stuff) I get from them. I have been using this drug store for years and we get great personal service. But I have a lot of maintenance scripts which I have filled at Optum Rx because it's so much cheaper. I asked my local pharmacist if he would bill Medicare Part B for my insulin (I always got my insulin there before 2012 when we had private insurance) and he did some research and said he could do it for strips but because insulin is covered by Part B only for pumpers it would be more difficult because he would require a license. He was delighted when I told him that I would get it mail order. Since I was the only one who made such a request and it would be expensive for him he was happy not to have to deal with it. Then late last year we got a Walgreen's nearby. Prior to that the closest Walgreen's was too far away. (Now they're opening up lots of them.) I spoke to the Walgreen's pharmacist and she said they had no experience with billing Part B for insulin but she said they would try when I need it. So I am waiting until I need it and hope they can do it. I know they already have the license. I'd be interested in hearing how the Walgreen's insulin order works out for you. My husband had prescriptions filled at Walgreen's (he has the same plans that I have) and the cost was the same as mail order cost. I am going to try Walgreen's for Synthroid because I have trouble convincing Optum Rx that I can't take the generic which they try to send me even though the script says "brand name medically necessary."

I love the new Bayer. I have two of them. One I got from Medtronic and the other I got through Medicare Part B and my Medigap.

When you got your 2nd meter, did you initiate it or how did you go about getting it? I know I have 3 One touch meters, a small one I take as a backup for travel, but I have to manually input the BGs, so I would love to have a 2nd Bayer for this, so it always goes directly to the pump.

I think I will check with the Walgreens before I really need the next 3 months of insulin, to be sure I can get it in time. We are going overseas for 3 months and I need to make sure I have all that I am due to make it through till we are home. Walgreens was more expensive for my statin drug(3 month supply) and for my sleeping pills. Does your Walgreens match the mail order prices on just some of the drugs?

[Arlene S.]

When you got your 2nd meter, did you initiate it or how did you go about getting it? I know I have 3 One touch meters, a small one I take as a backup for travel, but I have to manually input the BGs, so I would love to have a 2nd Bayer for this, so it always goes directly to the pump.

I think I will check with the Walgreens before I really need the next 3 months of insulin, to be sure I can get it in time. We are going overseas for 3 months and I need to make sure I have all that I am due to make it through till we are home. Walgreens was more expensive for my statin drug(3 month supply) and for my sleeping pills. Does your Walgreens match the mail order prices on just some of the drugs?

Medtronic sent me the first one. They sent them to everyone who has an x22 or x23 pump. Actually heard about it last November and I received it on December. I order my strips and supplies from Medtronic so when I was placing the order I said, "Medicare won't pay for another meter, will they?" and she said Part B and my supplement would and she sent me a second meter with my supplies. So if the meter CCS sent you was billed to Medicare you are entitled to another one from Medtronic. If I were you I would call Medtronic.

Walgreen's and my mail order are the same for some drugs but they cannot dispense a 90-day supply for all drugs. My statin, which is the generic Lipitor, is exactly the same price through mail order and Walgreen's. It's Lipitor and it just went generic in 2011 but only two companies were making the generic and the price for the generic was less than for the brand but it was still high. As of 2013 it went down to $15 for a three-month supply (from $55 for the generic). I did a comparison on the AARP website for all three places (my local, Optum Rx and Walgreen's) and found Walgreen's to be even cheaper for some drugs than Optum Rx. My local place is still the most expensive.

[susanhs]

Medtronic sent me the first one. They sent them to everyone who has an x22 or x23 pump. Actually heard about it last November and I received it on December. I order my strips and supplies from Medtronic so when I was placing the order I said, "Medicare won't pay for another meter, will they?" and she said Part B and my supplement would and she sent me a second meter with my supplies. So if the meter CCS sent you was billed to Medicare you are entitled to another one from Medtronic. If I were you I would call Medtronic.

Walgreen's and my mail order are the same for some drugs but they cannot dispense a 90-day supply for all drugs. My statin, which is the generic Lipitor, is exactly the same price through mail order and Walgreen's. It's Lipitor and it just went generic in 2011 but only two companies were making the generic and the price for the generic was less than for the brand but it was still high. As of 2013 it went down to $15 for a three-month supply (from $55 for the generic). I did a comparison on the AARP website for all three places (my local, Optum Rx and Walgreen's) and found Walgreen's to be even cheaper for some drugs than Optum Rx. My local place is still the most expensive.

Thanks, Arlene, I will call Medtronic!

[Arlene S.]

Thanks, Arlene, I will call Medtronic!

I don't know if this has changed but I had to call the 24-hour helpline for the Medtronic meter (that was last November).

Good luck with getting your supplies for your stay abroad.