Medicare Proposed Changes to Test Strip Allowance


I woke up about 3 AM with my Dexcom beeping at me that my BS was high.  I couldn’t go back to sleep so I decided to come downstairs and turn the computer on.  I started reading some posts on the ADA message board and Lathump, one of the board members there, had posted about what she read on the website.  I literally felt like I came downstairs to a nightmare.  Lathump posted a link to proposed Medicare changes to limit test strips to 6 tests a day for diabetics on insulin, pump or not – I posted that a little further down.

I don’t think that I need to convince anyone here the importance of testing.  Lathump pointed out the minimum that we should be testing per day:  before and after meals, before we get behind the wheel of a car (which you figure will be 2 times per trip) and before bed.  That does not count any time we feel low, we are sick or all the other reasons that we need to test our blood sugar.  It is insane to limit anyone to 6 tests per day.

I decided to write a letter to President Obama and submit it via the website.  I had a nice, long detailed letter written, but when I went to fill out the form, it said it should be limited to 2500 characters.  Mine was over 5,000 so I had to chop it down and take out a lot of good detail.  I had it down to about 2700 characters and I was able to submit that.  I will put a copy of that letter below, but I would encourage everyone to write the President as well as your senator and congressman.  This should never happen.  I did read a post on TuDiabetes not too long ago that this same thing happened in another country – I want to say that was France without trying to go find that post, but I am not 100% sure on the country.  So please do NOT sit back and think that something like this cannot happen.

Lathump also pointed out that a lot of insurance companies follow Medicare guidelines.  Even if you are not on Medicare, this can impact how many times a day you are allowed to test. 

Here is the link to the draft.  Please especially take note of the paragraphs on page 7, which I will copy here:

 For beneficiaries who are being treated with insulin injections more than once per day or on insulin pump therapy:

 • If basic coverage criteria (1)-(4) are met, test strips and lancets in excess of 400 strips and 400 lancets every 3 months will be denied as not reasonable and necessary unless criteria (a) and (b) are met.

 • If the beneficiary is using more than 400 strips and 400 lancets every 3 months and criteria (a) and (b) are met, test strips and lancets in excess of 600 every 3 months will be denied as not reasonable and necessary.

 As you can see, the way this is worded, your doctor cannot submit a form of medical necessity to get more test strips for you.  It will be denied as not reasonable and necessary.  Although the current plan does limit test strips, your doctor can submit a form of medical necessity and get more test strips for you.

All the studies talk about tight control reducing complications.  The rate of complications has actually decreased due to tight control.  We will be going back to the dark ages if this gets passed.  This is like handed a death sentence.

Here is the letter I submitted to President Obama:

Dear President Obama,

I became aware of a proposed change to Medicare regarding the number of test strips diabetics are allowed to use per day.  Cutting the number of test strips that I or my fellow diabetics are allowed to use is like having death squads go after us.  In this case it would not be grandma but every diabetic that takes insulin and anyone on the streets near a car being driving by a diabetic.  Private insurance companies follow Medicare guidelines so fear is that this will happen to every diabetic.

I am on disability because of complications from diabetes.  I have been fighting very hard to not allow those complications to get worse.  I have is gastroparesis.  Gastroparesis is nerve damage to the stomach which causes delayed stomach emptying.  Even though I follow a gastroparesis diet of very easy to digest foods, I don’t know when my food will decide to digest.  If I take too much insulin before my food digests, my blood sugar crashes low.  If my food decides to digest without enough insulin in my body, then my blood sugar goes high.  Neither of those situations are healthy, so therefore, I test frequently to try to prevent either from happening.

I am hypounaware, which means that I do not know when my blood sugar is low.  This is fairly common in diabetics that use insulin.  It is important to test blood sugar frequently to know if you are low or not so you don’t end up unconscious because of low blood sugar.  Passing out is dangerous. 

I no longer drive because of neuropathy.  However for those diabetics taking insulin that do drive, it is important for them to test their blood sugar each time they get behind the wheel.  There have been many instances of a diabetic’s blood sugar dropping low while they were driving and causing an accident.  That will endanger anyone on the road.

The proposed change to Medicare is to allow for 6 strips per day.  We should check before and after we eat so that is 6 strips right there.  Testing before getting behind the wheel is at last 2 more tests.  That totals 8 times a day. 

Those 8 tests do not include any extras for when blood sugar drops low.  Standard protocol for a low is to test and treat.  You also need to test again in 15 minutes and continue to repeat that process until your blood sugar comes up to a normal number. 

I am sure that you are aware of all the amputations caused by diabetes.  Maintaining good control helps limit those problems.  The only way to maintain control is to test frequently.  The proposed change to Medicare does not allow even the minimum amount of testing one should be doing per day.  This change will guarantee that amputation rates rise. 

I went thru a very bad foot wound and I would not wish that on anyone. Here is the link to those pictures on my blog:

I would be more than willing to sign a release so you could get both medical and billing records to see what the cost of my foot wound was.  It took 2 years from start to finish.  I spent several weeks in the hospital.  I had several surgeries.  I was on IV antibiotics for over 17 weeks.  I had home nurses coming in.  I saw at least 1 doctor ever 1-2 weeks for 20 months and then monthly the next 4 months. 

This change to Medicare will endanger every diabetic that takes insulin and they are guaranteed poor health.  I beg of you to not allow this to happen.
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