Medicare Part B Test Strip Refills While Traveling

[UTTransplant]

I was diagnosed with diabetes not too long ago, and I use blood glucose test strips each morning. Got around to ordering my next package of them, and the pharmacy told me that Medicare Part B does not allow transferring this type of prescription to another pharmacy! They will have to contact my doctor for a new prescription, even though the current one has 6 more refills on it. Of course, I had planned this refill based on our travels, and I can’t guarantee I will be in this place long enough to have them contact my doctor and get the new Rx. If I had known about this, I could have planned our trips differently, but now it is a mess. I just bought some OTC to get me by. I always knew you could have trouble with controlled medications, but diabetic test strip? Pretty ridiculous in my mind. But I thought I would let folks in my situation know so they can plan better than I did.

(Oh, and the Mounjaro I am taking brought my blood glucose down radically in the first week, and the level is still good. I’m doing fine, but I do need to check my fasting sugar every morning.)

 

[Edd505]

OTC so why a prescription other than someone else pays?

 

[UTTransplant]

OTC so why a prescription other than someone else pays?

Yup. It costs $30/50 strips OTC. If I get it with my Rx, it is almost $0. Now, $30 a month or so is definitely not going to break me, but this is why I pay insurance. It is just the idea of a non-transferable prescription for something as innocuous as diabetic test strips. This is definitely NOT a Class A drug!

 

[Arch Hoagland]

I've always thought somebody is making a ton of money on diabetic test strips.

 

[Domo]

Sounds like you need to call YOUR doctor and have them send the Rx to a national chain - such as Walmart, CVS, etc. That way you'll be "in the system" and should be able to get refills nationwide.

This is not a restricted/controlled drug - so it should be have an issue. And, bottom line, if it did in one location or another, spend the money and then submit the claim to your insurance company.

 

[UTTransplant]

Domo, it doesn’t work like that. It works just fine on all my other meds, but this is a Medicare rule. I have been traveling 7-8 months a year for the last 10+ years, and this is the only Rx that doesn’t transfer with a simple CVS app request. It is absolutely ridiculous. The pharmacist was quite apologetic as he explained it to me, but it is a basic restriction for Medicare Type B, the pharmacy benefits. I have an additional pharmacy benefit, and it doesn’t allow it either due to those pesky Medicare rules. Like I said, just a warning for others who might be in the same situation. We just figured out where we will be later in the week, and there is a CVS handy. I sent a request to my doctor about an hour ago. I should be able to pick them up later this week.

 

[John From Detroit]

I was diagnosed with diabetes not too long ago, and I use blood glucose test strips each morning. Got around to ordering my next package of them, and the pharmacy told me that Medicare Part B does not allow transferring this type of prescription to another pharmacy! They will have to contact my doctor for a new prescription, even though the current one has 6 more refills on it. Of course, I had planned this refill based on our travels, and I can’t guarantee I will be in this place long enough to have them contact my doctor and get the new Rx. If I had known about this, I could have planned our trips differently, but now it is a mess. I just bought some OTC to get me by. I always knew you could have trouble with controlled medications, but diabetic test strip? Pretty ridiculous in my mind. But I thought I would let folks in my situation know so they can plan better than I did.

(Oh, and the Mounjaro I am taking brought my blood glucose down radically in the first week, and the level is still good. I’m doing fine, but I do need to check my fasting sugar every morning.)

First Mounjaro is amazing stuff. When the dost hit the proper level I rather quickly resembled a black friday price tag (25% off) Went from 300 to 225 rather fast and insulin needs also dropped (I'm type 2 insulin requiring) Very happy with it this am.

I use a Libre Link system (CGM instead of test strips.)

I use a pharmacy like Optum RX (mail order) they can ship to you if you are parked for 2 weeks.
Or know where.. Since strips can be stored if you are moving let a CG know to expect you and the package. Also some pharmacies are more or less nation wide. I'm not sure which I know wal*mart each store has it's own data base but I think Walgreens is one database nation wide. KEY word is THINK. make sure you check it out.

 

[Gary RV_Wizard]

Medicare "B" has entirely different payment system/rules than Part "D" (drug coverage). B is set up primarily for hospitalization coverage but includes "Durable Medical Equipment" and home-use "Supplies". It's simply not set up to make repetitive "refills" easy to manage like the Part D system is. Back in the day some accountant put the test strips under Part B cause they weren't an actual drug and now we are stuck with it.

 

[Edd505]

Yup. It costs $30/50 strips OTC. If I get it with my Rx, it is almost $0. Now, $30 a month or so is definitely not going to break me, but this is why I pay insurance. It is just the idea of a non-transferable prescription for something as innocuous as diabetic test strips. This is definitely NOT a Class A drug!

I totally agree but for the $30 conveyance when traveling even a full years only $360. If you travel 2 months a year $60 I spend that on coffee a month and I don't do Starbucks or the other spendy stuff.

 

[John From Detroit]

I totally agree but for the $30 conveyance when traveling even a full years only $360. If you travel 2 months a year $60 I spend that on coffee a month and I don't do Starbucks or the other spendy stuff.

Yup. It costs $30/50 strips OTC. If I get it with my Rx, it is almost $0. Now, $30 a month or so is definitely not going to break me, but this is why I pay insurance. It is just the idea of a non-transferable prescription for something as innocuous as diabetic test strips. This is definitely NOT a Class A drug!

Test strips (Standard One Touch) are one of the very few things I will go to Wal*Mart for if I need them. PRICE is the reason. Just so you know.

With the CGMS I don't often need to do that but in the past I"ve had to and once when I had issues with the CGMS. Some years back when the MSRP was about a buck a strip.
Well the cost to make .. about 5 to 10 cents a strip.. Likely about double that now.

Ah the joys of greedy Medical gear makers.

 

[Jackiemac]

100 strips in the UK $18. Accu Check brand.

 

[Trivet]

Medicare "B" has entirely different payment system/rules than Part "D" (drug coverage). B is set up primarily for hospitalization coverage but includes "Durable Medical Equipment" and home-use "Supplies".

For the sake of accuracy, Part A is hospitalization coverage. Part B is medical insurance (e.g. doctor visits). As you noted, Part B covers durable medical equipment, and diabetes self-testing equipment and supplies are classified as durable medical equipment.

A government document explaining diabetes coverage says if you're not taking insulin you can get 100 test strips every three months, so if you can manage to get a prescription filled, it should last three months--still a hassle, but much better than having to do it every month.

The pharmacist was quite apologetic as he explained it to me, but it is a basic restriction for Medicare Type B, the pharmacy benefits. I have an additional pharmacy benefit, and it doesn’t allow it either

Also for the sake of accuracy, Part B doesn't provide pharmacy benefits. Some drugs can be covered by Part B, but only those that are administered by a healthcare provider (like chemotherapy drugs).

Your Part D prescription drug plan is not an "additional" pharmacy benefit. It's the pharmacy benefit. And as you found out, it doesn't cover test strips. FWIW, vaccines aren't covered by Part D, either, even if you get it done at a pharmacy. And when Covid tests were free at pharmacies, it was under Part B and not Part D--I had to fight a pharmacy about that one, since the one I went to wasn't in network with my Part D.

Thanks for posting about your issues. I learned something.

 

[RayIN]

First Mounjaro is amazing stuff. When the dost hit the proper level I rather quickly resembled a black friday price tag (25% off) Went from 300 to 225 rather fast and insulin needs also dropped (I'm type 2 insulin requiring) Very happy with it this am.

I use a Libre Link system (CGM instead of test strips.)

I use a pharmacy like Optum RX (mail order) they can ship to you if you are parked for 2 weeks.
Or know where.. Since strips can be stored if you are moving let a CG know to expect you and the package. Also some pharmacies are more or less nation wide. I'm not sure which I know wal*mart each store has it's own data base but I think Walgreens is one database nation wide. KEY word is THINK. make sure you check it out.

I agree John; CVS did that for my wife. Prescription was in our hometown. I asked a CVS in Florida to check with our hometown CVS. They filled DW's prescription the same day. WalMart pharmacy does that too.

 

[Gary RV_Wizard]

For the sake of accuracy, Part A is hospitalization coverage. Part B is medical insurance (e.g. doctor visits).

Right, but it's not quite that simple either. Part A covers the brick & motor part of the hospital stay once you are admitted, but the treatments you get there are Part B, i.e. provided by a doctor or other medical professional. Also included in Part B are out-patient services and screening exams/tests, and diagnostic tests unless performed as part on a Part hospitalization. Even if that "outpatient service" is physically performed in a hospital (e.g. the ER). You have to be part doctor, part accountant and part lawyer to figure it all out. I have a friend who makes a very nice living teaching hospital staff what gets charged to each class of Medicare services

 

[Trivet]

Right, but it's not quite that simple either.

I agree that it's complicated. I just wanted to correct the statement that Part B "is set up primarily for hospitalization coverage."

Part A (hospital insurance)​

Part A helps pay for inpatient care at:

• Hospitals
• Skilled nursing facilities
• Hospice

It also covers some outpatient home health care.

Part B (medical insurance)​

Part B helps cover:

• Services from doctors and other health care providers
• Outpatient care
• Home health care
• Durable medical equipment
• Some preventive services

https://www.ssa.gov/medicare/plan/medicare-parts

 

[Larry N.]

I agree John; CVS did that for my wife. Prescription was in our hometown. I asked a CVS in Florida to check with our hometown CVS. They filled DW's prescription the same day. WalMart pharmacy does that too.

Was it diabetic test strips? They are, indeed, a different animal from medications, as Gary and others have said above- I had to deal with that years ago (with straight medicare, and before Obama), including lots of paperwork. It has remained different from meds through today, from Medicare to now a Medicare Advantage program. They remain awkward to deal with when ANY change occurs.

 

[RayIN]

Was it diabetic test strips? They are, indeed, a different animal from medications, as Gary and others have said above- I had to deal with that years ago (with straight medicare, and before Obama), including lots of paperwork. It has remained different from meds through today, from Medicare to now a Medicare Advantage program. They remain awkward to deal with when ANY change occurs.

Regular scripts; my diabetic test strips were bought OTC at CVS; no prescription needed. reference: https://www.goodrx.com/conditions/diabetes/diabetic-test-strips
Of course buying them OTC requires sending in a claim form to the ins. co. for reimbursement if the expense is a burden.

 

[Larry N.]

Regular scripts; my diabetic test strips were bought OTC at CVS; no prescription needed.

Certainly- Pam said that too, but to get Medicare to pay for them is what this thread has been about (or so it seemed to me), not whether you can just go OTC.

 

[Trivet]

Of course buying them OTC requires sending in a claim form to the ins. co. for reimbursement if the expense is a burden.

Have you done that? Paid for them out-of-pocket and submitted a claim for reimbursement to Medicare?

 

[UTTransplant]

100 strips in the UK $18. Accu Check brand.

Yup, I use the AccuCheck Guide strips. Much cheaper in the UK! Hey, let me know when you’re coming, and I’ll buy a bunch from you! For a 75% savings I could pay for your postage from wherever you land in the US LOL!

I’m glad others have more clearly identified the difference between test strips and medications. I am so amazingly frustrated with the whole thing. I had heard there was an underground market for test strips, and now I think I know why.

And I couldn’t get John’s post in a quote, but yes, Mounjaro is fabulous! My blood glucose was in the 160s each morning before starting it, and in 3 days it was in the upper 90s! It bounces between low 100s and mid 90s, depending on whether I treated myself the night before. And I am still on the very first dose (2.5mg). I am lucky that I really haven’t had any side effects after the first week, and even those initial ones were so mild as to not be concerning at all. My PA and I are both agreed to just keep the low dose as long as my blood glucose levels are good. Oh, and I have also lost some weight, but that is not my primary goal. It has averaged a pound a week, a nice level I am quite comfortable with.

But I think I am just giving up on the Medicare-reimbursement until I get home. Until then I will just buy them OTC.