It was a wonderful day when Dexcom G6 was approved without the requirement for daily calibrations. One less chore in my diabetes life and fewer alarms interrupting my day. But unfortunately for many of us seniors, the labeling of Dexcom as therapeutic and non-adjunctive** has made it more difficult to receive Medicare-reimbursed test strips or at least the test strips of our choice.
** Per CMS Policy Article A52464: “A therapeutic or non-adjunctive CGM can be used to make treatment decisions without the need for a stand-alone BGM to confirm testing results.”
Like everything with Medicare, people are having totally different experiences with the test strip problem. Some seniors on Advantage Plans are able to get test strips in addition to CGM with no problem. A few people on Facebook claim to get coverage for 3 strips a day (the Medicare allowance for insulin users) from their pharmacy because the doctor wrote the prescription saying that the strips were for calibrating their Dexcom. Others have had no success getting pharmacy coverage for strips regardless of what the prescription specifies. I have read many times our Medicare CGM suppliers are required to provide a meter and I recently got a meter and strips from Solara. But it was not the meter and strips of my choice.
I started this blogpost ten days ago writing that I could find no CMS document outlining the exact guidelines for test strip coverage. All of my info was from word-of-mouth on diabetes social media. Then a few days ago a Facebook friend posted a link to Glucose Monitor – Policy Article A52464C as updated on 4/7/22. Finally for better or worse a clear delineation of the policy.
Some of the History
When Dexcom began providing Dexcom G5 to Medicare recipients in 2017, we were shipped a blood glucose meter and test strips packaged with our monthly sensor allowance. What was amazing was that Dexcom picked a high quality meter system (Contour Next by Bayer) for Medicare recipients rather than the cheapest kid on the block. At that point Contour Next was rated as the most accurate meter by the Diabetes Technological Society (DTS).
Meanwhile some pharmacies quit providing test strips to seniors on CGM due to Medicare denying payment because we were getting test strips from Dexcom. Fast forward to Dexcom G6 when Dexcom quit being a Medicare distributor and moved us to Walgreens and online DME suppliers. All of a sudden many of us were no longer getting test strips. It wasn’t a big deal to me because I had lots of extra strips that I used well past their expiration dates. Only now have I run out of those strips and need to investigate my alternatives.
The Present–My Interpretation
Despite the different experiences of Medicare recipients in getting test strip coverage along with CGM coverage, Glucose Monitor – Policy Article A52464C clearly outlines the policy. (Please note that Advantage Plans are Medicare benefits administered by private companies and can have different rules than Medicare. Similarly people with TRICARE and retiree plans can have different benefits. I am writing about Basic Medicare with or without a Supplement Plan.)
As stated above, Dexcom is labeled as a therapeutic and non-adjunctive CGM. The test strip policy is:
“For non-adjunctive CGMs, the supply allowance (K0553) also includes a home BGM and related supplies (test strips, lancets, lancing device, calibration solution, and batteries), if necessary. Supplies or accessories billed separately will be denied as unbundling.”
So yes, you can get test strips under Medicare as part of your CGM supplies. The crucial part of this policy is the mention of supplies billed separately being denied because of being “unbundled.”
Bundled versus unbundled. Bundled is when my CGM DME supplier provides me with a meter and strips as part of my Dexcom sensor order. Those test strips are covered by Medicare. Unbundled is when I try to get test strips from my pharmacy. Those test strips will be denied. Unfortunately to carry this further, bundled is when my CGM supplier sends me a cheap meter of its choice. Unbundled and denied by Medicare are strips for my highly rated Contour Next meter.
I do not have the knowledge to address the policy for Medtronic CGM users. Those sensors are considered adjunctive and it looks to me that meters and strips are not part of their bundle. So I wonder if Medtronic users can still get test strips at the pharmacy??? “For adjunctive CGMs, the supply allowance (A4238) encompasses all items necessary for the use of the device and includes but is not limited to, CGM sensors and transmitters. Separate billing of CGM sensors and transmitters will be denied as unbundling.” I also do not have experience with Libre and Eversense systems.
My Choices and My Experience
I don’t use a lot of test strips compared to pre-CGM days. Most of my testing is on Day 1 of new sensors when I consistently have erratic results and lots of false lows. I would estimate that I use 7-10 strips per sensor and I’ll call that 25 strips per month.
One choice is to keep using Contour Next and pay out of pocket. That is not as horrible as it sounds because Walmart and Amazon sell Contour Next strips labeled Over-The-Counter for $26.58 for 70 strips ($0.38/strip). Walmart also sells an online bundle of 200 strips for $54.99 ($0.27/strip). If I use 25 strips/month and thus about 300/year, I can get by on $81-$114 annually. I can afford that but not all people can.
A second choice is to use the Omnis Health Embrace meter and strips provided by Solara, my DME supplier. The upside: this choice has no out-of-pocket cost. The downside: did I mention that it is a Talking Meter? Fortunately I have good eyesight and don’t need a talking meter. But if I turn off the talking which is quite obnoxious, I get loud beeps that are equally obnoxious. Two other negatives are that the meter must be turned on and off and the strips are difficult to insert. Plus this meter did not pass DTS’s benchmark tests.
A third choice is to buy a cheap ReliOn meter system from Walmart. In the original DTS study, there was a Walmart meter that was rated highly and passed the benchmark tests. Walmart ReliOn Confirm Micro. When I go to the Walmart website, I can find the ReliOn Confirm Micro BG test strips but I cannot find the meter. So it is obviously not in production. About two months ago I purchased a ReliOn Premier Compact meter that included 50 Premier test strips for $19.88. My first two concurrent tests were 100 and 130. For me the most important accuracy test for a BG meter is repeatability. Those two tests were too far apart for me to have confidence in the meter and strips. It is now my fountain pop tester.
A fourth choice is that I bought a CVS Advantage meter and strips that were highly rated in the DTS study. So far the results have seemed reasonable and the OOP costs for strips are less than for Contour Next. But not a lot less.
I could go forever trying other meters and strips and I am not sure that there would be a definitive or right answer.
Interestingly yesterday morning, I did a bunch of BG tests, each with a new fingerpick of blood. The noisy Embrace meter tested 102-102 on tests two minutes apart. Repeatability: Surprisingly great. Then I used the CVS meter and got 107-118. Not exactly the same but meanwhile my Dexcom went 109-116. And then the Contour Next was 80-82. Repeatability great, but the numbers were totally out of the ballpark from the other meters and my sensor.
Today I did similar tests. Embrace meter 114-115. CVS 114-112. Contour Next 106-105. Dexcom sensor 134.
So what does this mean and what should I do?
I have no idea.
All I know is that according to a common saying: “A man with a watch knows what time it is. A man with two watches is never sure.”
Along that line: A woman with one meter knows her blood glucose. A woman with a CGM and three meters doesn’t have a clue.
TBD what I decide to do about test strips. I have a few months worth of Contour Next and CVS strips. I will continue to use the ReliOn strips for testing Diet Coke. But I am flummoxed that the Contour Next readings were significantly lower on the first tests than my Dexcom and the other meters and moderately lower on the second tests. And the free Embrace meter is being surprisingly consistent.