Type-2 diabetes + Insulin Pump + Medicare

rdrandal
By rdrandal Latest Reply 2014-07-19 22:38:41 -0500
Started 2014-07-17 22:15:46 -0500

About 14 years ago medication for my Type-2 diabetes could no longer control my blood-sugar levels so I began a regiment of insulin injection therapy. After several years I utilized an insulin pump for even better control. Everything was great until I retired and started Medicare. My mail-order pharmacy informed me this week that they would no longer offer my insulin if I used it in a pump. If I told them I used it only with injections they could continue to sell me the medication. WTF?

Medicare has requested that I take a number of tests before they would allow me to purchase pump supplies even though I have my doctor's prescription for the supplies. Every test I've taken shows that my pancreas produces insulin. This is common for a Type-2 diabetic. Because my test results don't match Type-1 results Medicare refuses to pay for my pump supplies.

Has anyone else experienced these issues with Medicare and if so…what can you do. I'd rather not go back to injections but it appears if I want any help from Medicare I'll be forced to. I always thought that good management of diabetes was important for a healthier life but apparently the government is more concerned about cost than maintaining good health in it's citizens.


8 replies

Type1Lou
Type1Lou 2014-07-19 15:02:54 -0500 Report

You only got part of the answer from your mail-order provider. Medicare does cover insulin used in a pump but it is covered under Medicare Part B. Insulin that is injected (not used in a pump) is covered under Medicare Part D (Prescriptions) I just became eligible for Medicare and researched this thoroughly since I use a pump. (Make sure your doctor's RX includes info that this insulin is used in a pump.) The good thing is that your pump's insulin costs will not be applied to any Part D "donut hole" amount. I would advise you to check the Medicare site that shows which providers are authorized to get you your insulin…there's a list of "approved Providers". Your pump manufacturer may be able to help you navigate through the Medicare approval process for a pump. I would arm myself with documentation showing any improvement in your diabetes control (A1c"s?) while using a pump if you have that. Perhaps your doctor can help provide that info? I am a Type 1 and I understand that they may need additional documentation from you as a Type 2. That might include a C-peptide test as well as your testing log book. It is FRUSTRATING to have to validate a treatment that you have been using to better manage your condition and maintain control. I just successfully battled with my Medicare Advantage provider about obtaining the pre-authorization for the test strips I use (also under Medicare Part B) since I test 8 times daily, more than is normally allowed under Medicare. I'm just about to get my pump supplies filled for the first time under Medicare and am keeping my fingers crossed that it will go smoothly. Wishing you well

rdrandal
rdrandal 2014-07-19 18:44:41 -0500 Report

Thank you for the information. It's important that individuals know their options when dealing with Medicare. I have Parts A, B and D but I wasn't aware costs could fall under Part-B. My AARP Part D provider suggested this particular mail-order pharmacy. Thank you again for the information. Everything helps when dealing with our government now

Type1Lou
Type1Lou 2014-07-19 19:17:08 -0500 Report

And how! Without sounding boastful, I think I'm pretty sharp and trying to navigate my way through all the options available was very confusing and frustrating. I became eligible in June and was apoplectic trying to get my test strips. After nearly daily calls for 2 weeks, I finally got it straightened out. I'll have to get the pre-authorization for test strips every year, but now, at least I know what to expect! There is a 20% co-pay for insulin under Part B. I'm actually paying a bit less than if I was purchasing insulin under Part D because it's considered a Tier 3 drug under Part D.

rdrandal
rdrandal 2014-07-19 10:14:54 -0500 Report

* Follow-up * I have a Dr appointment next week to discuss if I have any options such as trying medication again but I don't know if being on insulin for all these years will eliminate that option. If you use a mail-order pharmacy and use the pump for insulin beware! Medicare reimburses the pharmacy less for pump insulin than injection insulin (even though it's the same insulin). a majority of mail-order pharmacies are refusing to sell insulin if it's for use in a pump because they lose money (no profits). This may eventually spread to major non-mail order pharmacies. All of this is due to a new bidding system approved by our elected folks in congress. When you are forced to go back to insulin injections or worse, you can thank your elected officials for looking out for you. Ask them what their health insurance is like compared to yours.

diabeticdummy
diabeticdummy 2014-07-18 21:20:00 -0500 Report

have you seen how are vets are treated by a government insurance the V.A then the affordable care crap another under funded tightly regulated government program along with welfare, wic, Medicaid, medicare and any other government run program you can think of on overtaxed citizens and big kick backs to corporations and management officials and you thought you would get treated better ha ha they just help you along to keep paying taxes till you get expensive then oops if you can afford it even cheap insurance if they cover the pump supplies might be worth it, id rather just pay for the supplies cheaper than insurance i remember reading somewhere that insulin only costs like 40$ a bottle I'm trying to remember where i read that I'll let you know when it pops in my brain

haoleboy
haoleboy 2014-07-18 01:25:52 -0500 Report

I cannot speak to your specific issue however … my significant other and I have been on Medicare since the first of the year and can testify that without a doubt the government is more concerned about cost than maintaining good health in it's citizens.
that said … I am grateful that I have health coverage, as imperfect as it is it is better than nothing (which is what I had before)

namaste
-Steve

rdrandal
rdrandal 2014-07-18 10:19:23 -0500 Report

Steve, you are correct about health coverage but it could be much better considering the money spent within the United States. I wish you both the best of health.

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