Test Strips and Politics

by gary scheiner MS, CDE

Have you heard? Medicare, in its infinite wisdom, is slashing prices (cutting reimbursement by more than two thirds) for blood glucose test strips starting this July. And because private health insurance tends to follow Medicare's lead, there could well be a ripple effect into the greater diabetes community (although some payers cut prices made to companies long ago). Medicare's decision will not only affect people with diabetes. It will also affect manufacturers who rely on test strip sales to fund things like new product development and educational programs. And that will have an effect on healthcare providers who are already strapped for time, as well as the pharmacies we use for obtaining our supplies.

For many of us who check our blood sugar routinely in order to stay healthy, test strip costs are not usually a major concern. But that's about to change. If your insurance company decides to reduce its coverage for test strips, it may mean a large increase in out-of-pocket costs. And for someone who checks their blood sugar five times daily, reduced insurance coverage could mean an additional $1,000 or more per year in out-of-pocket test strip costs. (Unfortunately, changing lancets once a year instead of once a month will not make up the difference. I did the math.)

But hey, we're nothing if not adaptable. As PWDs, we've persevered through stuff that would make others wilt and die. When our doctors had little more than 15 minutes every three months to spend with us, we went out and learned the latest treatment methods on our own. When the rigors of daily self-care got us down, we turned to our peers in the social media for a pick-me-up. And when the insurance industry was slow to pick up on medical and technological improvements, we stomped our feet and banged our heads until things changed. Suffice to say, even with this test strip apocalypse bearing down on us, we are not without good options.

1. Ask for assistance.

Most meter manufacturers offer “copay cards” that help to offset out-of-pocket costs for test strips. In some cases, a flat dollar amount is provided towards your purchase every time you fill a prescription. In other cases, the card will cover any cost above a specific amount. Abbott (Freestyle), Bayer (Contour) and Roche (Accu-Chek) all have these types of programs available. Call the number on the back of your meter for more details.

2. Stock up.

Again, Medicare’s coverage changes won’t go into effect until at least July 2013, and it may take much longer for private health insurers to follow suit. In the meantime, order as many strips as your plan allows and store them in a cool dark place. The expiration date on most strips is a couple of years after the manufacture date, so you should be able to keep yourself stocked for quite some time.

3. Fight your plan (if they are increasing your co-pay).

Most insurance plans will make exceptions for individuals with special needs. For example you might need a meter with a particularly bright or large screen due to visual limitations, or perhaps a meter that communicates with your pump, or one that works at a certain altitude or temperature, or even one that generates specific reports for your physician. It helps to have a “Letter of Medical Necessity” from your physician, stating the exact reason why you need to use a certain type of meter, and how those needs cannot be met with lower-priced options.

Also, some health plans will cover glucose test strips under a “major medical” benefit rather than a “pharmacy” benefit or vice versa. It may be to your advantage to switch the benefit area that your test strips are billed to if it results in better coverage. In other words, learning the system may help you to save a bundle.

4. If it is a matter between testing and not testing, switch to a generic meter.

Never thought I’d hear myself say that. But the fact is, some generic meters may be as accurate and easy to use as brand-name systems. When evaluating meter accuracy, the two stats I look at are: 1) The percentage of readings that are within 10 mg/dl of the lab value when BG is below 75 mg/dl, and 2) The percentage of readings that are within 10% of the lab value when BG is above 75. I find that these are critical values since they allow us to capture our lows and treat our highs in a safe manner. Below are some stats for a handful of currently-available brand name meters; this data can usually be found in the technical specifications of the meter user guides. 

Now here’s the same data for some common “generic” meters:

* Only information available

The International Organization for Standardization (ISO) guideline calls for home blood glucose meters to be within 15 mg/dl of the lab value when the BG is below 75 mg/dl and within 20% of the lab value when above 75 at least 95% of the time.  My guidelines (as shown above) are a bit more stringent.

As you can see, there isn’t a whole lot of difference in the claims. This is self-reported data from all the companies, and the lots used from generic meters can be suspect (all lots tested are supposed to be “representative” but they aren’t always) – as could lots used from any company, of course. My point is that testing with a generic meter is better than not checking at all. Some also stay away from generic meters because they don’t feel these companies invest in education or next-generation technology.  

Of course, switching to a generic meter may not be the best option if you are using a pump that links directly with a certain brand-name blood glucose meter, or if you need certain download or performance capabilities. But, if this is the only choice, being able to test your blood glucose is clearly the most important.

5. Consider testing less if you are on CGM.

Testing less not something I ever thought I would recommend.  But for some patients, particularly those on CGM, that may be possible. For patients on the latest continuous glucose monitors (the Dexcom G4, specifically), this CGM performs at a high enough level that between-meal fingersticks may not be necessary. As long as the CGM has been matching recent calibrations closely and the glucose level is relatively steady (“lag time” still has an effect on accuracy), glucose values generated by the CGM can often be taken at face value. Of course, if your CGM is being reimbursed, the strip cost may not be affecting you.

6. Deal with it.

Not everything we need to stay healthy is covered by health insurance. Nor should it be. If you are determined to keep using your preferred meter even if your health plan won’t cover the majority of the test strip cost, you may just have to bite the bullet. At least in the United States, these types of out-of-pocket health care costs can be applied to a pre-tax healthcare spending account (HSA) or flexible spending account (FSA), which effectively reduces your cost by 20-30%.

Who knows what the future holds. Maybe we’ll all have to start rationing blood glucose test strips. Or maybe there will be such an upheaval that insurance plans will reverse their decision.  Or maybe, just maybe, we’ll all be cured before this all goes into effect. Now wouldn’t that be nice?

Note: Gary Scheiner is Owner and Clinical Director of Integrated Diabetes Services (www.integrateddiabetes.com), and serves as “Dean” of Type-1 University (www.type1university.com). He and his team provide diabetes consultations throughout the world via phone and the Internet. Author of several books, including Think Like A Pancreas and Until There Is A Cure, Gary is a Masters level exercise physiologist and has been a Certified Diabetes Educator for 17 years. He has had type-1 diabetes since 1985, and makes use of all the latest “gadgetry” in his own diabetes management, as well as that of his clients. He can be reached toll-free: 877-735-3648; outside the US: (011) 610-642-6055; or by e-mail: gary@integrateddiabetes.com.