getting test strips from Minimed, insurance changes driving me crazy! Options

[Liz]

As of August 1st, when our Empire BCBS plan renewed at my job, I am going to have a 50% co-pay for all DME. I had been getting my One Touch test strips from Edgepark for close to two years now and they were billed as DME. Before that I got them through the pharmacy but on January 1, 2009 my insurance put a limit of 200/month on strips as a pharmacy/drug benefit. By going through Edgepark I was able to avoid the limit and avoid a drug co-pay but that was only $10/month or $20/3 months through mail order.

I called Edgepark yesterday to cancel my account with them as I can't afford to pay 50% for the strips. I have a new script from my CDE written the same as always but I know if I mail it to the pharmacy they'll send me 600 strips for 90 days and say that was the limit. I would then have to spend countless hours making phone calls and my CDE/endo would have extra work as well.

I called Minimed yesterday to see what they had to say since they always seem very knowledgeable about insurance issues. She did some checking and then said they would definitely be able to send me 400/month but I would have to get them on a monthly basis, not every 90 days. I can only get 90 days at a time through the official mail order pharmacy which is now Express Scripts (used to be NextRx and before that it was Caremark). If I get strips anywhere else, locally or mail order, I can get 30 days at a time only. The woman at Minimed said my cost would be $60/month for 400 strips which doesn't make any sense to me. The strips were always counted as a generic drug/co-pay which is $10. The brand name is $35 and non-formulary is $75. None of those are $60. We *do* have a very small deductible for brand name drugs bought anywhere other than Express Scripts and that's $50. So I'm thinking maybe the $60 figure is the initial $10 co-pay plus the $50 deductible and after that it will be only $10. If the strips as counted as generic there really shouldn't be a deductible, though. I get my only brand name drug, Advair, through mail order and so I've never had to worry about that deductible.

If I stay with Edgepark I'd pay 50% which would be something like $500+ every 3 months. If I walk into a local pharmacy I can pay only $10/month but get 200 strips without any problems. If Minimed is $60/month for 400 I think I might just go for that, pay the extra money and avoid all fights and wasted time trying to get the limit raised.

Anyone getting strips from MM? I forgot to ask if they still have some kind of offer for the free UltraLink meter. Also, she said they had a valid prescription for strips on file because it's something they routinely ask the endo for along with scripts for the pump supplies. She said they would call and get a new one if needed so that's one less thing I have to do.

[Manxman]

Liz,

In early July I took advantage of the free Ultralink meter with a big order of strips being offered by MM. My primary insurance is Medicare, secondary is HealthNet. My Rx drugs come from a HealthNet mail order pharmacy, which recently raised my copay on the One Touch strips that are sent in 90 day supplies of 600 strips (6 tests per day). My order of 600 strips and free meter from MM came at zero copay. I will be ordering all future strips from MM, not from HealthNet.

[Linda B]

If I stay with Edgepark I'd pay 50% which would be something like $500+ every 3 months. If I walk into a local pharmacy I can pay only $10/month but get 200 strips without any problems. If Minimed is $60/month for 400 I think I might just go for that, pay the extra money and avoid all fights and wasted time trying to get the limit raised.

Anyone getting strips from MM? I forgot to ask if they still have some kind of offer for the free UltraLink meter. Also, she said they had a valid prescription for strips on file because it's something they routinely ask the endo for along with scripts for the pump supplies. She said they would call and get a new one if needed so that's one less thing I have to do.

Since 200 / month is not enough strips; I agree that you are probably best off to go with MM. You will have the right number of strips and your cost would be $180 for 90 days instead of $500. I also think there's a good chance your copay might reduce to $10 / month after the initial $50 deductible is met. If that's a concern, you should be able to call MM and ask if the $60 was $50 deductible plus $10 copay.

I'm surprised that you use 400 / month. I am limited to 200 at a time. I am allowed to refill every 20 days because the doctor wrote a script for 10 / day. I average 8 / day. I reorder through my pharmacy a little early each time, after about 25 days. I have never come close to running out.

Linda B.

[Liz]

Since 200 / month is not enough strips; I agree that you are probably best off to go with MM. You will have the right number of strips and your cost would be $180 for 90 days instead of $500. I also think there's a good chance your copay might reduce to $10 / month after the initial $50 deductible is met. If that's a concern, you should be able to call MM and ask if the $60 was $50 deductible plus $10 copay.

I'm surprised that you use 400 / month. I am limited to 200 at a time. I am allowed to refill every 20 days because the doctor wrote a script for 10 / day. I average 8 / day. I reorder through my pharmacy a little early each time, after about 25 days. I have never come close to running out.

Linda B.

When I mentioned the $50 deductible to the woman at Minimed she wasn't really able to tell me if that was the reason for the $60 charge. My prescription is written the same as it was before CGMS, 15x daily. I honestly don't usually test 15 times unless I have no sensor in or the sensor is not trustworthy. When I've had a bad sensor I end up testing way more than I would if I just shut it off, because I was constantly wondering if my BG was really doing what the sensor showed. Still, I just checked my pump average and it was 10.8 for the past 14 days. I tend to slack off a little on the weekends but during the week when I'm at work and more active I do test often. I've already tested 8 times today due to a bad set/site. (IMG:style_emoticons/default/sad.gif) I put in a Sure-T today it my arm and it seems like it didn't work. Saw my BG going up fast while on the bus going to work. Sensor showed 142, meter was 250!! I got my kit out and took an injection on the bus and moved the set when I got to work. I hope the new site works but it's been hard to tell since my BG is coming down so slowly. I just bolused for lunch (BG was finally down to 145) but will wait 20-30 minutes before eating. I did the manual injection around 9:50am and those do not get included in the IOB calculation so there's still some of that left 3 hours later. I also did a correction when I moved the needle of the Sure-T once I got to work. If lunch doesn't work out I'll just insert a Silhouette. When the Sure-Ts work they're great but they are the only set that gives me trouble. I'm not sure if I'll order any more. I never have a problem in my left arm but I have in my right, which is where I inserted today (sensor is in my right thigh). I also couldn't use my upper butt/lower back area so the Sure-T is of limited use to me.

I don't know if the local pharmacy would let me renew early. I had a huge fight once when I brought in my new script for 2 vials of Humalog one time. They gave me only one because they said 2 vials was more than a 30 day supply. I pointed out that 1 vial was less than a 30 day supply. I gave up and that's when I switched to mail order. I still get my insulin, Advair & Levoxyl through the mail order pharmacy, 90 days at a time for 2 co-pays each.

Liz,

In early July I took advantage of the free Ultralink meter with a big order of strips being offered by MM. My primary insurance is Medicare, secondary is HealthNet. My Rx drugs come from a HealthNet mail order pharmacy, which recently raised my copay on the One Touch strips that are sent in 90 day supplies of 600 strips (6 tests per day). My order of 600 strips and free meter from MM came at zero copay. I will be ordering all future strips from MM, not from HealthNet.

Do you ever run short getting only 200 strips a month? My days can be very different from each other. For the past couple of weeks it's been very stressful at work so that changes things for me. Eating the same breakfast every day can have vastly different results. I can't imagine testing only 6 times a day. I'm sure at some point I'd go back to passing out and I don't want that.

This post has been edited by Liz: Aug 19 2010, 04:58 PM

[Manxman]

"Do you ever run short getting only 200 strips a month? My days can be very different from each other. For the past couple of weeks it's been very stressful at work so that changes things for me. Eating the same breakfast every day can have vastly different results. I can't imagine testing only 6 times a day. I'm sure at some point I'd go back to passing out and I don't want that. "

At six strips per day, a 90 day supply is 540 strips. My orders are shipped in a 600 strip quantity, which gives me 60 extra over the 90 day period for the occasional troublesome periods requiring more than six tests per day. This works fine for me. In the event that I ever needed more strips than that, I would just buy them out of pocket.

This post has been edited by Manxman: Aug 19 2010, 06:09 PM

[jbkjr]

I prefer to ger my stips from the pharmacy. I get 250 for the month. I just checked and I have checked 6.6 times per day for the last month. My copay is 7 bucks. Just went down from 10. I go to a really small pharmacy in a town of 1200 so I know everyone there and have known them since i was a kid. I think my presciption is for 8 times a day. I don't care for the order process with MM. I use to have a mail order and i got my 90 supply without having to order or send in a card. One month from MM I will get a postcard and one month I have to go online and order.

[Liz]

I prefer to ger my stips from the pharmacy. I get 250 for the month. I just checked and I have checked 6.6 times per day for the last month. My copay is 7 bucks. Just went down from 10. I go to a really small pharmacy in a town of 1200 so I know everyone there and have known them since i was a kid. I think my presciption is for 8 times a day. I don't care for the order process with MM. I use to have a mail order and i got my 90 supply without having to order or send in a card. One month from MM I will get a postcard and one month I have to go online and order.

There are fewer & fewer independent pharmacies around these days. The pharmacy nearest my apartment is independent but their hours and my schedule don't mesh. I also have to use a pharmacy that's in network with my insurance so that's another consideration. I was very worried about using the mail order pharmacy at first but I have had very few problems. I only had problems when Caremark was bought by CVS but my insurance switched to another company soon after. Caremark prior to CVS was great.

I was always on autoship with Minimed so I never had to do anything to get my supplies. I took myself off that earlier this year and I've never gotten any kind of reminder from them. When you call their order department you hear a message reminding you to send in your postcard and I always wondered what that was. My last few orders I called and placed them over the phone because the online store wasn't working properly. It's too bad that Minimed can't send 90 days of strips at a time along with my supplies. The woman I spoke with today also told me that I'd probably be paying around $200 every 3 months for pump supplies, excluding sensors.

[Randy]

I've never filed on insurance to pay for my test strips. I just paid out-of-pocket and was done with it. Now, Medtronics is auto-shipping me strips every month (4 boxes of 50, 200 strips total). I've reached my maximum costs this year so insurance is paying 100% for my supplies and meds. I'm in coverage heaven right now! (IMG:style_emoticons/default/biggrin.gif)

[Peter B]

I'm really shocked to hear that MM has good prices on strips. I have been getting 6/day in 90 day supply increments for years now which I've found to be pretty sufficient for me. Depending what I'm doing, I don't always need 6 which leaves me with extras when I do need them.
As to what different insurance plans offer, it's going to vary not just by the comapany and the coverage. A lot of states have different mandates for strips and medical supplies for diabetics.
Usually, and unfortunately, I"ve had to change insurance a lot of the last 5-6 years and maybe due to Maryland regulations, I've never had a problem with limits. Usually it's a $40-60 copay for 90 days from the mail phamacy.
Question- cell phones are given away so you buy minutes and cell plans have come down over the last 20 years. Why haven't strip costs come down?? Compared to 10-12 years ago as BG kits became more common, the costs have remained pretty steady, despite what I would imagine is a 10- fold increase(guestimate) in numbers sold. There is a reason they are so well advertised now; they're making a killing on them for what I consider a small marketplace for them.
Peter

[JohnG]

I use 8 strips every day, one for each meal and one 2 hours after each meal + 1 wake up and 1 bead time.
(on good days) on bad days the sky's the limit. On a good day I could easily get by using only 4 strips
but my CareLink data would have big holes in it.


I would not consider 4-5 billion dollars a year a small market place and that is just a conservative estimate
for the US market on test strips. MiniMed sold 1.2 billion dollars worth of pumps and supplies in 2010 their
physical year ended in June. Diabetes is just a small piece of Medtronic and MiniMed only brings in 8% of their
total sales. They sold 5+ billion dollars worth of pacemakers and their total sales was over 15 billion.

The test strip market is universal, all PWD,s need them. It's like the tobacco industry without any guilt.

JohnG

[Peter B]

I would not consider 4-5 billion dollars a year a small market place and that is just a conservative estimate
for the US market on test strips. MiniMed sold 1.2 billion dollars worth of pumps and supplies in 2010 their
physical year ended in June. Diabetes is just a small piece of Medtronic and MiniMed only brings in 8% of their
total sales. They sold 5+ billion dollars worth of pacemakers and their total sales was over 15 billion.

The test strip market is universal, all PWD,s need them. It's like the tobacco industry without any guilt.

JohnG

John G-
I had no idea that test strips had that kind of market!! As it gets that large, you'd think that prices would come down. I haven't check various manufacturer's prices lately, but when I swithed from Roche, the prices were very similar. You'd think in a market that big, with all the various manufacturers, somebody would try to be a little more competitive?!
MM and all the big guys are pulling in the bucks, no doubt about that!!
Peter

This post has been edited by Peter B: Aug 27 2010, 01:36 AM

[Manxman]

What we don't know is the actual, negotiated price that insurance companies actually pay for any brand of strips to the suppliers. But to the insurance companies, the insured patients who USE the strips/meters are far less of a risk to their bottom line than the people who don't use them. With so many insurance companies paying for the provided strips, there is no need for the retail price to fall for out-of-pocket buyers.

This post has been edited by Manxman: Aug 27 2010, 01:44 AM

[Peter B]

With so many insurance companies paying for the provided strips, there is no need for the retail price to fall for out-of-pocket buyers.

Very true and a good point! You never do see what the negotiated price of our rx benefits are versus you do see it on BOE's for just about all other services. I'm still amazed at some of the things you see! I've had a bunch of blood work done lately and I think Labcorp's original bill was about $220. for one full screen and the negotiated price was somewhere around $35.00. I'm sure Labcorp still made a nice return at that price. I had hernia surgery about a year ago and my surgeon billed close to $1800 and the negotiated price was around $500. I don't ever recall seeing anything about rx like that on a BOE. The power of our pharmaceutical industry!!!!
Peter

[Arlene S.]

Very true and a good point! You never do see what the negotiated price of our rx benefits are versus you do see it on BOE's for just about all other services. I'm still amazed at some of the things you see! I've had a bunch of blood work done lately and I think Labcorp's original bill was about $220. for one full screen and the negotiated price was somewhere around $35.00. I'm sure Labcorp still made a nice return at that price. I had hernia surgery about a year ago and my surgeon billed close to $1800 and the negotiated price was around $500. I don't ever recall seeing anything about rx like that on a BOE. The power of our pharmaceutical industry!!!!
Peter

While I never see an EOB for my meds and strips I am able to see what my plan pays for strips by going to Medco's website.

[Liz]

While I never see an EOB for my meds and strips I am able to see what my plan pays for strips by going to Medco's website.

I have been getting EOBs for my strips since I've been getting them as DME through Edgepark. Their "list" price is astronomical! For 1,250 strips (3 months supply based on 15x day) Edgepark bills my insurance $1,645.85 and insurance pays $587.25. I've stopped my Edgepark orders and I think I'm just going to go ahead and call Minimed and switch over to them. Even if they charge me $60/month, $180 is still less than 50% of the insurance price of $587.

[Arlene S.]

I have been getting EOBs for my strips since I've been getting them as DME through Edgepark. Their "list" price is astronomical! For 1,250 strips (3 months supply based on 15x day) Edgepark bills my insurance $1,645.85 and insurance pays $587.25. I've stopped my Edgepark orders and I think I'm just going to go ahead and call Minimed and switch over to them. Even if they charge me $60/month, $180 is still less than 50% of the insurance price of $587.

It has been a couple of years since I got my strips and other supplies from Edgepark but now that I think of it I did get EOBs from them. I seem to recall that they billed much higher than MM for pump supplies. (I was getting my pump supplies from them because I was told by someone at my insurance company that I had to go through Edgepark for everything but insulin--it turned out not to be true.)

[Liz]

I called Minimed today to reorder my test strips. It had been a little over 5 weeks since my first order from them. For that first order they said my co-pay was $60. In the past my strips co-pay was just $10 when I got them as a pharmacy benefit. Today when I called they said my co-pay was $10. I think that my first order was $60 because there's a $50 drug deductible on my plan if you don't use the official mail order pharmacy. I'm going through Minimed because my insurance also has a 200 strip per month limit, but Minimed said they won't have a problem sending me 400. 400 is a little too much (same script from before CGMS) but 200 isn't enough. I still test frequently even with the sensors because sometimes they're just not reliable. In another thread I complained that my last few sensors aren't catching lows after breakfast. My BG when I got to work today was 48 but the sensor shows 117. I would not have known unless I tested.