In July 2013, Medicare launched a new National Mail-Order Program for diabetic testing supplies, including blood glucose test strips, lancets, lancet devices, batteries, and control solution.
As a certified diabetes educator (CDE), I have received a lot of questions about this. People with diabetes rely on the accuracy and ease of use of their blood glucose meter. It helps them make daily diabetes self-care decisions about food intake, physical activity, and, most importantly, dosing of insulin and other diabetes medications.
Let me answer your questions. Once you know the changes, you can work with your diabetes care team (diabetes specialist, primary care provider, and certified diabetes educator) to choose an accurate blood glucose meter that meets your needs at an affordable cost.
I use Medicare Advantage. Does this change affect me?
No, if you are enrolled in a Medicare Advantage Plan or commercial managed care plan, you are not affected by this change.
What are the changes?
A new Medicare rule was put into effect. It affects how people with diabetes (who are covered by Medicare Part B) get blood glucose meters and diabetes testing supplies. Medicare recipients are now required to buy diabetes testing supplies from a Medicare-approved local pharmacy, or a Medicare national mail order contract supplier. Diabetes testing supplies may still be purchased from a local pharmacy; however, you need to make sure that the pharmacy accepts Medicare “assignment” so you don’t pay more.
Many pharmacies participating in the Medicare program have designated a “preferred brand” of blood glucose meter and testing supplies. They are encouraging Medicare patients to change to this meter. This is often a less expensive generic blood glucose meter.
What is Medicare “assignment”?
After you pay your annual Medicare Part B deductible, Medicare pays 80 percent of the Medicare-approved amount for supplies. This is the “assignment.” You are responsible for 20 percent of the cost. If the mail order or local pharmacy accepts the Medicare “assignment” for your diabetes supplies, you cannot be charged more than a 20 percent co-payment. If a pharmacy does not accept Medicare assignment, or you choose to use a blood glucose meter that is not a “preferred brand,” you may be charged more than the 20 percent co-payment. Co-payments and additional costs of testing supplies for a meter other than “a preferred brand” are often covered by supplemental insurance.
Are blood glucose meters interchangeable?
No. Per the American Association of Diabetes Educator’s (AADE): “Blood glucose testing systems are not interchangeable, and physicians often prescribe, and patients often choose, particular meters for important clinical reasons.”
Do I have to change blood glucose meters and testing supplies?
No. Mail order and local pharmacies are not allowed to influence you or provide an incentive to change to a “preferred brand” of blood glucose meter and testing supplies. The National Mail-Order Program for diabetes testing supplies does not require that you change meters. It must provide the brand of testing supplies that works with your choice of blood glucose meter.
Contact the Customer Service Department for your meter if you have difficulty finding a Medicare-approved local pharmacy or Medicare national mail order contract supplier for your diabetes testing supplies. The number for Customer Service Department can be found on the back of your meter.
Is the “preferred brand” of blood glucose meter as accurate as my current meter?
Some generic blood glucose meters and testing supplies are very accurate while others are not. Try comparing the accuracy of the “preferred brand” to your present meter. You could also talk to your diabetes care team for a meter recommendation.
What should I do if I have special needs and am not able to use “the preferred brand” of blood glucose meter or lancet device?
The new Medicare rules allow you to obtain a specific blood glucose meter and testing supplies, if medically required. Your medical provider must prescribe the specific blood glucose meter and testing supplies you require and document in your medical record that you need this product to avoid an adverse medical outcome.
What should I do if I choose to change to a “preferred brand” of blood glucose meter and diabetes testing supplies?
Please discuss any changes in blood glucose meters with your diabetes care team (diabetes specialist, primary care provider, and certified diabetes educator). Your diabetes care team will help you develop a plan to transition to a new meter.
Who do I contact for more information?
To find a Medicare supplier in your area and for more information, call 1-800-MEDICARE (1-800-633-4227) or visit www.medicare.gov/supplier.
Linda Tilton, MS, RD, CDE, is a Clinical Dietitian and Certified Diabetes Educator at The University of Vermont Medical Center. In 2013, The UVM Medical Center earned national certification in diabetes education. Learn more about The UVM Medical Center’s Endocrinology, Metabolism and Nutrition practice. Linda is also the coordinating board chair for the Vermont Association of Diabetes Educators.