Apidra and Medicare: Good News!

Apidra and LevemirLast week after a reader contacted me that Apidra was not coming up on the Medicare search tool, I contacted Sanofi-Aventis. I came home Friday to find an email with some good news. Apparently, Medicare made a mistake in not including Apidra in the search tool. Most Medicare plans will still cover Apidra. Unfortunately, because the search tool will not help you, you have to go to each available plan’s website (or call them) to find out whether or not they will cover Apidra. The person at Sanofi also told me that if it is not coming up on the plan’s list, to call them to make sure because they might not have the latest available updates on the website.

My pharmacy was closed when we got back from Pittsburgh Friday evening, so I gave my two prescriptions to my mother to pick up. Saturday morning, I logged into my plan’s website to see if the Dakin’s solution would be covered – the wound center told me that it might not be covered. I noticed that they had the 2013 formulary up so I looked to see if Apidra was on there and it wasn’t. I then looked at one of the other plans in my area and they did have it.

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Apidra and Medicare

Yesterday, a reader emailed me and said that her Medicare Advantage Plan was no longer covering Apidra.  When she went to the Medicare website, no plans were coming up that covered it.

I went to the Medicare site and typed in Apidra to see if any plans covered it.  Apidra was no longer in their system.  I saw this:

Medicare and Apidra

I Googled Avodart – that has something to do with the prostrate gland.  Not quite the same drug category as Apidra!

Thinking maybe someone misspelled it (although unlikely because it was there last year, but you never know), I looked at the drugs in the A list and didn’t see any misspellings.  I looked for insulin glulisine and it didn’t come up that way either.  Lantus, Levemir, Humalog and Novolog were all there.  Only Apidra was missing.  Oh joy!
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PFQC’s Philadelphia Town Hall Teleconference

People For Quality Care BadgeLast week I mentioned that I had participated in a town hall teleconference call sponsored by People For Quality Care (PFQC).

Yesterday I saw on the PFQC’s Facebook page that HME News, the Business Newspaper for Home Medical Equipment Providers, published an article about that town hall. During the call, participants were invited to answer poll questions. One of those questions asked if they knew about competitive bidding. 100% of the people responding to the poll question did not know about it. Philadelphia is in the next round of areas to be added to competitive bidding. I think that it is really sad that people were not aware of what is going to happen.

You can read the full HME News article here, but I wanted to share part of what I stated during that teleconference:

Booth, who lives outside Pittsburgh, a Round 1 bid area, said she’s heard that beneficiaries in that area are having trouble getting quality test strips and are having to wait to receive supplies.

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Medicare and CGMS Coverage

Dexcom Double Down Arrow LowSomeone recently landed on my blog using the search term “how to get a Dexcom approved by Medicare.” If you want to believe the standard line that Medicare doesn’t cover a CGMS, then I suggest you not waste your time reading this article. If you aren’t willing to accept the standard answer, then keep reading. I am on Medicare and have a Medicare Advantage Plan. Guess what, they paid for both a Freestyle Navigator and a Dexcom.

If you try to get a CGMS with Medicare, you are going to be told that it isn’t covered. And yes, I heard the “your insurance doesn’t cover that” plenty of times. Abbott told me that when I tried to get the Navigator and Dexcom told me that when I tried to get the Dexcom. Dexcom also told me that even after I had been using the Dexcom for a year and my insurance had been paying for it. I also heard it from supply companies. I have seen that statement made repeatedly on diabetes message boards but if I ask if they tried to file an appeal with their insurance company, they just repeat again that it isn’t covered. Sometimes even with traditional insurance, you have to fight for what you need. Medicare is no different.

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Medicare, Test Strips and Competitive Bidding

If you have read my blog in the past, you are aware that on January 1st, Medicare put into effect a competitive bidding rule for certain areas of the country.  Part of that rule changes how and where you can get test strips.  I have also posted that I am an advocate for People for Quality Care.  PFQC has a Facebook group that you can follow the activity and problems related to competitive bidding.

This week, I heard about a guy named Lowell having problems getting test strips.  Besides the problems in finding a new supplier, he also was told that he would have to switch brands of test strips.  If you read my first post on this issue Medicare 2011 DME Changes),  you know that I am concerned about suppliers substituting cheaper strips because they are now getting paid one low price no matter what brand of test strips that they send you.

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Reporting Medicare Competitive Bidding Problems

When I did the More Information on the Medicare Bidding Program post, I mentioned that the American Association for Homecare had a place on their website to submit problems with the competitive bidding program. Michael Reinemer, American Association for Homecare, left a comment on that post with another website and phone number. I copied his comment here:

Also, providers, consumers, clinicians and others can report concerns or complaints about the competitive bidding system by visiting http://www.biddingfeedback.com or by calling a toll-free number, 1-888-990-0499.

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