30 days hath September,
April, June and November.
All the rest have 31.
And February’s great with 28
And Leap Year’s February’s fine with 29.
Medicare rations diabetes supplies on a strict 30-day or 90-day cycle. My Medicare suppliers are even worse and tend to think that months have 35 days and quarters have about 95-100 days.
Unfortunately no one has communicated that to my diabetes which trucks along with a strict 24/7/365 (or 24/7/366 in a Leap year) schedule.
I continue to rejoice that my Dexcom G5 CGM is covered by Medicare, but it has been frustrating that Medicare currently requires Dexcom to send out supplies monthly rather than quarterly. The personnel and shipping costs for Dexcom for this monthly distribution are probably substantial and every month seems to leak a few days between shipments. In 2018 most of my shipments were a couple of days to a week late and over the course of 12 months, I only received 11 Dexcom shipments. My guess is that my experience is reflective of that of most Medicare beneficiaries. That means that Dexcom lost one monthly subscription fee for each of us and that is a lot of money for a small company. I was lucky to come into Medicare with a cushion of CGM supplies and I have been okay with constantly late deliveries. I also know about Spike and xDrip where you can reset G5 transmitters to last longer than the software-mandated death of 90-104 days. But some Medicare users have had to go without their CGM when sensors and particularly transmitters have been delayed. There is sometimes an excuse such as backordered transmitters or insurance verification. This month I placed my order on the designated day and the very nice Dexcom rep offered no excuse when she said it wouldn’t ship for another week.
I have been most impacted by pump supplies. I went on Medicare in April of 2017 and I received my 4 boxes of pump supplies like clockwork. Medicare strictly requires that each infusion set will last 3 days and allows no cushion for painful or failed sites. Or aging skin and tissue which require 2 day sets changes. Or steel cannula sets which mandate a 2 day change. In 2017 my doctor’s letter of medical necessity for 4 boxes instead of 3 was accepted and I got the needed supplies. My first order of 2018 was shorted a box and the supplier was unwilling to work with me to override the restriction. I switched suppliers and seeming the override was fine. But they sent the order 10 days late. In infusion set language, 10 days is half a box of supplies for me. Then 3 months later, they wouldn’t send my order until 92 days had passed. Then the next order was another 10 days late.
I have recently switched to Tandem TruSteel sets and seem to have better insulin absorption than with my previous VariSoft sets. And guess what! You can move the needle part of the set, reinsert it, and tape it down to get another day or two from the set. After two days, 90% of my TruSteel sites are slightly inflamed. So you go, Grandma!. Pull out the needle and tack it into another location. So far I have had no real infections and fortunately am very pain-sensitive and don’t try to extend puffy sites. But we all know that one ER visit or hospitalization would quickly blast past my Medicare-approved cost of $5.91 per infusion set.
Meanwhile diabetes keeps trucking along.
1, 2, 3, 4…..90 days.
If I did not extend infusion sets and have a stash, I would run out of supplies.
Medicare teaches you to lie. When you call your supplier to renew your 90-day supply, you can’t have more than a week (or is it 10 days?) worth of pump supplies in your D-tub. I would never in a million years be comfortable being down to 3 or 4 infusion sets before ordering more. With Dexcom the policy seem to be more liberal and I can get 5 sensors and 3 boxes of test strips if I am out of supplies. But even a failed transmitter doesn’t seem to get me better than 3-day shipping. My suppliers have failed me in the past and I don’t trust them to bail me out in an emergency. So I always tell them that I have fewer supplies than I really have. Because….
Diabetes keeps trucking along.
I have never sold excess supplies and I no longer share excess supplies. But as someone who has lived with Type 1 diabetes for 42 years, I know that I cannot risk being without insulin for 5 minutes or pump supplies for 5 hours or CGM supplies for 5 days.
One of my Medicare diabetes online friends once told me that every 90 days she feels as though she is recreating the wheel and resetting her diabetes life. With Dexcom it is every 30 days.
I get it now. That’s the game. And that is the game I play.
Your post is very timely and is spot on with my visit with Dexcom this morning for my now late order of G5 supplies. I had a similar conversation last month with my insulin pump supplier and parts for same.
CMS/Medicare certainly works with a calendar that none of us T1Ds (or even T2Ds) have seen or would likely be able to understand.
Nolan-Our FB posts earlier today were the inspiration for this blogpost.
Reading what you have been going through, lets me know that I’m not crazy.
At least with the Dexcom G5, we can restart the sensors and use them again when supplies get delivered late. The transmitters also will go for 120 days.
Pump supplies are another story. CCS Medical was unable to deliver the supplies one month (they were out of stock). I got them 12 days late. That reset the calendar for me. They also only let me have 30 insets and cartridges, even though my doctor has said that I need 45 and submitted the exact language that CCS said was necessary.
If any lawyers are reading this, I think that the time has come for a class action suit against Medicare.
I was initially with CCS Medical and found them efficient and easy to work with. But they were no help when I got to 2018 and they said that Medicare rules changed. I switched to Solara and a wonderful rep helped me override some of the 2018 restrictions but the experience is not nearly as efficient as with CCS and supplies are never sent on time.
The other issue is the restriction on test strips once approved by Medicate for CGM. You can be out of CGM supplies AND out of test strips. What a terrible position to put people in with T1 diabetes!
I find that I have to tell fibs (lies) in order to get my Medicare supplies. My purveyor does do the 30 day calendar just like clockwork. But thankfully I started Medicare with a little bit of stock pile. So when they call they always tell me they cannot send new supplies unless I have less than seven days supply. Yes I am long on supplies from a previous insurance but I find I need to say I have less than seven days with each order. Gosh I hate telling fibs (lies).
And my integrity compass doesn’t say that we are wrong. The game is wrong and the rules of the game are wrong. And of course diabetes is a PITA.
All I can say is me too. All of your posts resonate with me. Thank you for writing and posting them.
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