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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No Go on the Ping to MM Trade-In

Animas Temp BasalA friend of mine called me yesterday afternoon. She has been a MM pump user for years and when we were talking, she asked me if I had contacted MM yet to see about trading in my Ping. I told her that I haven’t done that. I don’t have the money to do that today so was holding off until I would have the money, although I was curious about what it would cost me.

Not too long after we hung up, the phone rang. I saw “Medtronic” on the caller ID so I knew that she must have done something! When I picked up the phone, the guy introduced himself and said that he was calling from Medtronic. He told me that my friend had called and told them that I was interested in getting a pump. I guess that is one way to get my butt moving! She needed to call them about something else anyway so I know she didn’t just call because of me.

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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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The Dreaded Formulary Change

Levemir and Apidra pensEvery year, I cringe when the packet comes with my plan’s changes for the upcoming year. Late yesterday afternoon, I went over for my mail and my insurance stuff was there. It was not good. After first looking at the part that had all the $$$ increases that I can’t afford, I pulled out the formulary booklet to look at that. I was only on the very first drug when everything came to a screeching halt. Apidra will not be covered in 2012. Only a little over a week after finding out there will be an Apidra SoloSTAR shortage and worrying about how I will survive a couple months without it, I am now being told I can’t have it period.

I would like to say that I felt like someone put a gun to my head, but putting a gun to my head would be too easy. I have neuropathy, both peripheral and autonomic. I have gastroparesis. Apidra is out of my system in 2 ½ hours. It is the best insulin that I have used. I can take a shot of Apidra every hour to keep my blood sugar stable after eating. I can’t do that with Novolog or Humalog. In the almost 3 ½ years that I have been using Apidra, I have managed to keep my A1cs in the 5s other than one 6.1 and the 6.1 was because of all the pump problems I had. I was never able to do that with the other insulins. I have fought so hard to keep my blood sugar under control and try to keep the complications I have at bay. Now I am basically being told you get to die but you have to die a very slow painful death from neuropathy.

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Diabetic Test Strips: Round Two

For those of you that think what happens to Medicare won’t impact you, stop and think about how many people you have seen say that their insurance company follows Medicare guidelines. If you use a local supply store and that store closes because of what is going on with Medicare, that impacts you. Even if you mail order your supplies from a company and that company has to close up shop, you will need to find another supplier. The way Medicare is implementing this program is causing a lot of suppliers to go out of business. When you have to wait weeks or months to get what you need because there are not very many suppliers to choose from, that impacts you.

I first wrote about the Medicare Competitive Bidding Program back in December. That program went into place January 1st in nine areas of the country. Since the program started, there have been numerous problems reported. Medicare however seems oblivious to those problems and is moving forward with round two. At this point, it will not matter whether or not you live in one of the affected areas, if you are diabetic and use test strips, with round two you need to get them from one of the suppliers chosen by Medicare.

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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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