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.