[Previous Months][Date Index][Thread Index][Join - Register][Login]   Help@Insulin-Pumpers.org
  [Message Prev][Message Next][Thread Prev][Thread Next]   for subscribe/unsubscribe assistance

Re: [IP] Medco/test strips FYI

 A few years ago I had problems getting my strips at the pharmacy by my job, but
that was due to one pharmacist's decision on what HE thought I should have. He
insisted my insurance only covered 200 strips/month, not the 300 I was getting
at the time. He lied and claimed he called my insurance and that's what he was
told and that when he put the order through on the computer, it rejected 300
strips. When I called my insurance to find out (the number was on the back of my
ID card) they told me that I would have to speak with pharmacy benefits, which
at the time was Caremark. I thought it was odd that the insurance company
couldn't tell me what they covered but Caremark was very helpful. They told me
my insurance did not impose any limits on the strips, that the prescription had
been entered as 200 right from the start and there was no issues with it and no
phone calls were ever made. She told me to return to the pharmacy and get the
pharmacist's name
  and make a complaint. After another fight with him, I got the last box of
strips and started using mail order after that.

 Late last year my insurance sent letters saying they would no longer be using
Caremark, but their own in-house mail order pharmacy instead. They also said
that some drugs might move to a different co-pay tier and limits would be
imposed on some drugs. Looking through the new formulary they sent I saw that
all test strips now had a 200/month limit AND they moved to the brand name ($35)
co-pay tier, along with insulin and all other diabetes drugs which had
previously been at the generic ($10) co-pay.

 I am now getting around the test strip limit by getting them covered as DME
through Edgepark. Not only can I get the number of strips I need but there is no
co-pay. Two years ago I remember my insurance sent a letter saying I could avoid
co-pays on test strips by using Edgepark but I never bothered to investigate
since my co-pay was only $10, and not worth the hassle of switching. I just
received my second shipment from Edgepark (I get 90 days at a time) and so far,
so good.

 I would urge everyone to see if their strips can be covered under DME instead
of prescription. Some people have plans that will work either way and it's
sometimes cheaper to use one over the other. My plan obviously covers them as
DME and prescription and for me it's better to get them as DME. I have Empire
BCBS in New York.

Type 1 dx 4/1987
Minimed 722 + CGMS
for HELP or to subscribe/unsubscribe/change list versions,
contact: HELP@insulin-pumpers.org