Medicare and diabetes

Type1Lou
By Type1Lou Latest Reply 2015-10-19 18:53:40 -0500
Started 2014-06-14 13:57:12 -0500

I just became eligible for Medicare on June 1. (I elected a Humana Medicare Advantage PPO as my Medicare plan…this MAY have been a mistake.) In the process of trying to get my first Medicare prescriptions filled through RightSource, Humana's preferred pharmacy, here's what happened.

On Thursday, June 12, I spoke with a diabetes rep, Lola, at RightSource to order my first diabetic test strip order. I told Lola I was on an insulin pump and used the Contour Next meter which communicates with my pump. Lola also indicated I was eligible to receive a new meter and that they would fax my doctor for the RX. The new RX did not appear on the RightSource My account site until this morning (Saturday). I was surprised to see that, without contacting me, the order had been changed to a OneTouch meter and One Touch Ultra strips. I called RightSource this morning and spoke with Megan in the diabetes supply area. I explained that I do not want a One Touch Meter (I already have 2 older ones), that the Bayer Contour Next Link meter is the one I use because it is more accurate and it communicates with my insulin pump. I would prefer to get the Contour Next strips to use with it. Megan then advised me that RightSource does not carry the Contour Next Strips. Why wasn't I told this on Thursday??????! When I asked Megan to cancel the order, she advised I would have to call back on Monday since the people that could do that were not available on Saturday. I REALLY do not want to get a meter that I will, in all likelihood, not use,; I could use the One Touch test strips with my older meters but would prefer the more accurate Contour next strips. I hope, that when I am able to call on Monday (after 10 am because of prior commitments) that I will not be told that the order has been processed for shipping. I am upset that changes to my request were made without the courtesy of notifying me. It could result is costly wastefulness, not to mention the aggravation (I just did mention it, didn't I?) I may opt to keep the One Touch test strip order because I may be locked into the Humana Medicare Advantage plan until next year and may not be able to get my strips at a lower cost elsewhere. What is interesting is that the pricing on Humana's site for the One Touch strips is $147.08/100 strips vs $89.20/100 for the Contour Next Strips…and we wonder why Medicare costs are skyrocketing!

Right Source is in the process of filling my insulin RX but they are "investigating" my RX's for levothyroxine, lisinopril, simvastatin and premarin cream. All came from the same physician. It's a good thing I began this process early, before I got too low on my supplies. I'll be making more calls for clarification and options on Monday. Any input from others with experience in Medicare is appreciated.


40 replies

Anonymous
Anonymous 2015-10-18 14:40:37 -0500 Report

hello my name is steve Crawford I am 65 & I have been on the mini med insulin pump since 1989 & I love, it ,I hve been also wearing thedexcom cgm although it is not always as your correct blood sugar readings if you don't surprise it with a sugar spike is really the only time that accuracy is incorrect that's why you will still need to synchronize the two on the low sugar it is normaly right on the money I set my low alert at 70 hope this helps best regards steve Crawford.

Outback1342
Outback1342 2015-10-18 14:19:38 -0500 Report

swtch to united health insurance they are helpful when it comes to any & all diabetic needs ive been with them for several years & they have had any issues plus I wear the insulin pump and the dexcom g4 cgm continuious glucose moniter my a1c, are usualy in the mid 6 range,best regards steve Crawford.

Type1Lou
Type1Lou 2015-10-18 18:15:55 -0500 Report

Steve, my problems with Medicare continue. At the beginning of this year, I switched to Basic Medicare with a Medicare Supplement and Part D Prescription Drug plan from AARP/United Healthcare. My March insulin RX was denied by Medicare in May and reversed upon appeal in August…5 months later. I got a new RX in July but when I went to refill it last Thursday (10/15) I was advised it was not eligible for refill until December…I'm now attempting to straighten that out with my doctor. Prior to Medicare, I have to say that any problems getting prescriptions were fewer. I use a pump but no CGM because there is no CGM coverage under Medicare. My last A1c was 6.9 Are you on Medicare?

Outback1342
Outback1342 2015-10-19 18:53:40 -0500 Report

hello that's a pretty good number & good self control if you can maintain an an a1c in the sixes the cgm is not always right on but if you don't eat or do anything out of your daily normal exersice or carbs it does give a certain sence of additional control but can be off by 50 to 100 against a finger stick but I have compared glucose meters & they can differ by quite a margin I recommend contour by bayer I personally am required to use the one touch verio there meter is almost exactly the same as my drs actual blood drawn from the vein .

Outback1342
Outback1342 2015-10-18 18:21:32 -0500 Report

IF YOU HAVE AARP THROUGH UNITED HEALTHCARE & LIVE IN BROWARD CO. FLA I CAN GIVE YOU MY DRS NAME & NUMBER.

Type1Lou
Type1Lou 2015-10-19 15:15:57 -0500 Report

Sorry…I'm in west Central Florida. The Medicare coding requirements are primarily what is causing the problem (and Medicare just changed their diagnostic codes in October). When used in an insulin pump, insulin is covered under Medicare Part b vs Part D where injected insulin is covered. Part B items don't count towards the "donut hole". After Walmart called to advise me they had filled my new Insulin RX on Part D, I recontacted my doctor's office I just educated a staffer in my doctor's office as to the need to include a proper diagnostic code on any insulin RX for someone who pumps…it never seems to end!

Type1Lou
Type1Lou 2014-06-26 10:30:10 -0500 Report

Just an update…I finally obtained the pre-authorization needed for the volume of test strips that I use. (After many many contacts with Humana and Right Source and my doctor faxing them info three times.) It took two weeks of persistence and aggravation to get here. I've ordered my test strips through Right Source/Humana and the order has gone through! Hurray!!! (What a relief!)

Type1Lou
Type1Lou 2014-06-17 06:56:34 -0500 Report

Here's some more icing for that dealing with Humana/RightSource cupcake..
On Saturday, when I became aware of the substitution, I posted a comment on the RightSource Facebook page. I got a reply mid-morning on Monday, after I had already called them to attempt to stop the meter order. The reply asked me to forward my concerns via e-mail to an address Humana. I did so, including the text of the posts I had written on the RightSource Facebook page and, at the end, had added my Humana ID #. The reply I received, (pretty promptly, actually) asked me to supply my Humana ID so they could further investigate the matter…I replied that if they had read the content of what I had e-mailed, they would have seen my Humana ID …Sheesh! and other expletives!

KBLegg
KBLegg 2014-06-16 20:29:37 -0500 Report

I've been down this road, too. I would suggest that you obtain an original written prescription from your doctor. Be sure the doctor's Rx includes the diagnostic code for your condition, i.e. for Type 1 or Type 2. I use a Walgreen's that accepts Medicare Type B items. Be sure to make a copy of the Rx before handing it over to the pharmacy. Yes, it will show "void" on the copy, but you will benefit from having that copy in case there's push-back from Medicare.

4mouseketeers
4mouseketeers 2014-06-16 11:19:46 -0500 Report

I am not on insulin yet. I take pills. But after the hassle with Medicare regarding the strips, I am going to Walmart & purchasing my own meter & strips. The company I retired from is making Medicare eligible retirees switch to a different plan in 2015. I think it will be most difficult.

robintellis
robintellis 2014-06-16 10:39:05 -0500 Report

Well, to all of you that have written about the troubles in getting your test strips. I am having the same problems. It is a night mare! When I ask questions, I often get, "I really don't have an answer for you." This is from my insurance co. The doctor's office people give the same answer. Other patients are having the same problems. (OK Robin, calm down.) Good luck to you all.

Type1Lou
Type1Lou 2014-06-16 11:28:04 -0500 Report

I made a call this morning to Walgreens since thay are an approved in-network pharmacy for my Humana PPO. I wanted to confirm the info from the Humana site that I could get my Contour Next strips for around a $30 co-pay for 3 months. While very polite, the Walgreen rep advised me that they were unable to give me that information until they had received the prescription…so, we can't even get the answers that will help us make the best decisions…very frustrating! Right Source would provide me with the One Touch strips at no cost…Perplexing how how RightSource can provide them for free while the Walgreen's invokes the 20% copay of Medicare Part B… It does want to make me SCREAM!…but I'm controlling myself!

Type1Lou
Type1Lou 2014-06-16 10:10:14 -0500 Report

Ok, here's an update on my dealings with Humana. They took it upon themselves to change my 6/12 request from Contour Next strips to One Touch and added an order for the OneTouch Ultra 2 Glucose System (meter) WITHOUT CONSULTING ME! (Strike 1) It wasn't until I called back on Saturday that I was told that Right Source, Humana's mail order pharmacy, does not carry the Contour Next Strips and that I was advised to call back on Monday to cancel the order for the meter that I do not want or need. (Strike 2) The One Touch Ultra 2 meter does not communicate with my pump. I spoke with a Humana rep this morning (Monday) in an attempt to cancel the meter order since I have no need for it nor will I use it; I decided I would let them send the One Touch strips since I do have an older OneTouch Ultralink meter that communicates with my insulin pump and can use the strips until I determine whether getting the Contour Next Strips through a local in-network pharmacy is a viable option for me. The Humana rep advised me to call my doctor and just have them decline approval for the Ultra 2 meter…??!!! (Strike 3) Such is Humana's Customer Service! I couldn't escalate that handling issue since I had to leave for an appointment. I did call my doctor and was able to intercept the order. They will not OK a new One Touch meter…hooray! Humana, after less than 3 weeks as a member, in my book…You're out!

Anonymous
Anonymous 2014-06-15 21:33:37 -0500 Report

Tell that company that you told them what use.you spoke with Megan and she understood…thats Medicare fraud. So when you call back you tell them that..
medicare is paying for it. That company is not. they choose to ignore you and sale it to you any way. Tell them you will notify medicare compliance office. Get names first and last …dates and times …DOCUMENT your dealing with every company

Type1Lou
Type1Lou 2014-06-16 06:57:19 -0500 Report

I've learned to keep a log of all my contacts and names of parties I've spoken to. I'm hoping to be able to cancel the meter shipment this morning since I don't need it, won't use it and it's wasteful!…we taxpayers are paying for this waste!

RebDee
RebDee 2014-06-15 12:07:18 -0500 Report

I too have a Medicare question. My medicare goes directly to Kaiser Permanente here in California. Two weeks ago I had a flood in the main bathroom and because there was lead and asbestos on the floors, Farmer's Insurance (home owners) will pay to redecorate my bathroom with comparable fixtures. However, since I am finding it harder and harder to get into and out of my tub, I would like to change to a walk in tub and separate stand up shower. Farmer's adjuster says that the additional money should be paid by Medicare. I have a letter from my Kaiser primary care physician. Now how should I proceed so that I get a usable bathroom back in a timely manner? And with no cost to me?

RebDee
RebDee 2014-06-15 12:00:22 -0500 Report

As an aside, I won't use Premarin cream as anything that takes off my nail polish as I spread it on, can't be good for my private parts.

Gabby
GabbyPA 2014-06-15 09:29:43 -0500 Report

My husband is on Freedom and there are all kinds of weirdness that happens the start of each cycle. Once we get them ironed out, we are usually okay, but you would think that if things don't change, why have to go through all the hoops every year. We are actually considering going back to just plain old Medicare for him. It has more options. All of the HMO's and PPO's have issues. Though a PPO is much better than an HMO which is what his Freedom insurance is.

Type1Lou
Type1Lou 2014-06-15 11:45:44 -0500 Report

Thanks for the input Gabby! I believe I can get my Contour Next test strips through a local in-network pharmacy like WalMart or Walgreens. I'll be calling the pharmacies tomorrow to verify what my costs would be…I believe it is subject to a 20% copay under Medicare Part B but need to verify… so instead of no cost for the OneTouch strips via RightSource, it looks like my Co-pay for 90 days would be $30 or so which is considerably less than what my co-pay was through Blue Cross before I became Medicare eligible. So happy to have any coverage!

RebDee
RebDee 2014-06-15 12:11:14 -0500 Report

If your insulin pump is through Medtronics, it may be possible to get your strips through them for free with your insurance. If your pharmacy does not have the right brand. Call them and ask. At least they will tell you what to do as they want their equipment to work at its optimum.

Type1Lou
Type1Lou 2014-06-15 14:17:29 -0500 Report

The meter and test strips are made by Bayer and I can get them through a local in-network pharmacy, just not Humana's Right Source Pharmacy. Medtronic has nothing to do with the test strips. Although, I did get replacement infusion sets and reservoirs for my pump through Medtronic. One of my questions for Humana tomorrow is who should I be getting these from now under their Medicare PPO so I don't get penalized and get stuck for the full $515 cost every 3 months.

MoeGig
MoeGig 2014-06-15 07:23:50 -0500 Report

Been on Medicare for four years now with Kaiser Permanente and they have been great. Now, I don't use a cgm or pump and don't have medi-gap insurance. My only complaint is the cost of Lantus. But my insurance cost deducted from my Social Security check is only $125 per month. I think the way Kaiser delivers medical care should be the model for the US. All the doctors work for the organization—you go one place for meds, gp's, specialists, labs and everything is on-line and integrated. No complaints here.

RebDee
RebDee 2014-06-15 12:19:55 -0500 Report

I'm a fellow Kaiser Permanente patient. I love how everything is right there. But sometimes, they don't understand what it is that I want when I specifically give the brand of strips for my small meter versus my larger more combersome meter that I keep at home and send me the same strips all the time. So I bring in the boxes of each and show them what I want. But it is an ongoing battle and one that I repeat every three months. Kaiser allows you to get a three months supply of medications for the price of a two months supply for all medications but of course, they don't charge at all for the strips.

Type1Lou
Type1Lou 2014-06-15 08:28:05 -0500 Report

Thanks for your input Moe. I'm new to Medicare and Kaiser is not an option in my corner of Florida (I thought health care options in general were better when I lived in New England.) Happy you found a plan that is working for you.

mustangpeg
mustangpeg 2014-06-14 19:04:11 -0500 Report

I have decided to go with the OmniPod because it has no tubes and I am on the CSM now and it is with Dexcom which is compatible with that pump. Plus it's simple and the simpler the better for me. So glad to hear you like the pump. I am a little scared but looking forward to it as I am taking 5 shots a day now. Any advice you can share will be appreciated. What kind of pump do you have.

Type1Lou
Type1Lou 2014-06-15 08:32:44 -0500 Report

I'm using a Metronic Minimed Paradigm 523 pump. It does have tubes. I tested out an Omnipod since they offered to send a free trial one (you couldn't actually make it active) that gave you experience for what it would feel like. I've been happy with Medtronic and believe they are in the forefront in the development of an artificial pancreas with their Minimed 530G pump with Enlite (CGM). I can understand the attractiveness of the tubeless and waterproof Omnipod…let us know how you like it.

RebDee
RebDee 2014-06-15 12:27:23 -0500 Report

I too have a Medtronics Mini-Med Paradigm 523 pump with tubes for the past 7 years and love it. No more shots and just a change in equipment and insulin when the pump says 'LOW RESERVOIR." It's so easy. Of course I can't wear it in the pool or shower but then I take my clothese off to do that anyway so just put the pump on "Suspend" and when you put it back on, hit "resume". Its easy to get used to it. Don't tell anyone but I wear it in my bra like a third boob!!

haoleboy
haoleboy 2014-06-14 17:00:16 -0500 Report

The only coverage that is worse than Medicare is no coverage … which is what I had for for years prior.
As I deal with the frustrations of putting up with the never ending BS that is required by Medicare I try and keep that in mind
(and some days it actually helps)

Steve

mustangpeg
mustangpeg 2014-06-14 16:27:21 -0500 Report

Sorry you are having so much trouble but thanks for sharing this info. I too will be on Medicare in Jan and am nervous about which plan to use and costs. Right now on my husband's insurance and it is great. I will also be going on the pump in a few months, so really concerned about costs and getting the right plan. I have made a list of questions to help me avoid some of the problems you are having. For us type 1 it is scary because we have to have insulin and our meds to survive. Thank you for bringing this to our attention and best of luck to you in resolving this.

Type1Lou
Type1Lou 2014-06-14 17:09:14 -0500 Report

I tried to get answers to some of these questions BEFORE I signed up but I could never get a definitive answer from Humana and other plans until I had signed up and had an ID number…how's that for a Catch 22? I'll keep posting about what I find out. Thanks for the encouragement. I love pumping and have only been doing it since 2011 even though I was diagnosed in 1976. My only regret is that I didn't opt for the CGM's while I still had other insurance. Medicare doesn't cover CGM's but they do cover the test strips and pumps and pump reservoirs and infusion sets…although, that's another thing I need to discuss with Humana since I've heard that one of their HMO plans will no longer cover the Medtronic Minimed pumps and supplies after August 1. I'm using their medicare Advantage PPO so it might not apply to my plan but I'd rather be sure. I hope you love your pump too. Have you decided which one you're getting?

Trudie Ann
Trudie Ann 2014-06-14 15:45:51 -0500 Report

I am sorry, but I'm not on Medicare, nor is any of my personal friends. I have been on Fed.BCBS for nearly 40 years and I was able to keep it when I retired. I have gone through ups and downs as their coverage changes and their premiums, but in the long run there is nothing better available for me. The biggest problem I have is finding speciality doctors in my network. Especially diabetic specialist. Of course what my insurance does or pays etc. will not be of any help for you. Best Wishes.

Type1Lou
Type1Lou 2014-06-14 17:12:59 -0500 Report

Thanks Trudie Ann! I worked in the insurance industry for 24 years and understand the need for cost containment. Prior to June 1, I had a BCBS plan through my husband's retirement and, as you noted, there are adjustments to be made from year to year. Maybe my frustration tolerance level is waning as I get older?

neverlowbg
neverlowbg 2014-06-14 14:13:13 -0500 Report

As I am on same meter you use cause of my pump now some meds were changed to generic but those were not on there covered list either so I love my doc she knows what paperwork to file to get me covered for what I need to have so talk to your dr about that letter of necessity and see if you get farther with Medicare than phone calls she did in a couple hours what I had fought for 2 weeks in phone with ins company

Type1Lou
Type1Lou 2014-06-14 14:27:55 -0500 Report

All of the drugs ordered are in the Humana formulary. Premarin is Tier 3 while the others are generic and Tier 1. I'll be calling them on Monday and hope to find out what the holdup is.

neverlowbg
neverlowbg 2014-06-14 14:09:21 -0500 Report

I don't have Medicare yet but I have had same problem with express scrips and my insurance after telling them off due to I got a different story every time I called and then when scrips were to fill would get letters in mail saying they would not cover meds or whatever and then it listed alternatives they covered wich were more exspencive doesn't make sence to me but the kick backs must be awesome to insurance companies I told my dr about issues and that she would have to change my scrips she said no go home wait for call from pharmacy to get meds I did four hrs later got my call meds ready went and picked them up and they were the meds I was prescribed I called dr and told her she didn't have to pay for them for me and she said she didn't my insurance did she wrote them a letter and her nurse filled out there form for necessity use and they approved all of it including 300 test strips a month

Type1Lou
Type1Lou 2014-06-14 14:34:52 -0500 Report

ExpressScripts managed my RX plan until I became eligible for Medicare on June 1. I reverted back to the OneTouch test strips at the beginning of this year since Express Scripts would only cover the One Touch strips as of January 1, 2014; all others would be denied. The meter that originally came with my pump in 2011 was a OneTouch Ultra Link and communicates with my pump, so, I am able to use the strips…they just are not as accurate. I'm glad your doctor was able to work things out for you!

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