Ever since qualifying for Medicare a number of years ago, it’s been difficult to obtain an adequate amount of supplies to maintain my good control. My goal has been to keep my A1c in the low 6’s. Primarily, the difficulties arise because of Medicare “norms” for approving glucose test strips (before I began using a CGM in 2019) and the “norms” for infusion site changes. I have had Type 1 diabetes since 1976.
I went through repeated Medicare appeals of denials before obtaining approval (18 months after the initial denial) for the 8 test strips per day I had been using prior to Medicare. I undertook filing those appeals myself after my doctor and pharmacy got nowhere with Medicare. (Medicare’s “norm” is for 3 test strips per day for someone using insulin and one test strips per day for a non-insulin diabetic.) I was preparing my final (4th) Medicare appeal which required an appearance before a Medicare judge when I was advised that Medicare would cover my 8 test strips per day.
In the last few years, my insulin absorption on Day 3 of my insulin pump site becomes less effective, resulting in higher glucose readings despite repeated corrections. My endo’s case notes supporting the need to change infusion sites more frequently than every 3 days (Medicare’s “norm”) MUST be submitted to Medicare every 9 to 12 months for me to receive 45 infusion sets for changing sites every 2 days. I will try to make my sites last longer than 2 days but frequently require 50% more insulin on day 3 of a site in order to maintain control. I’ve programmed a “Day 3” profile in my Tandem t:slim pump (w/Control IQ) so the pump gives me more basal and bolus insulin when I need to use my site into Day 3. Medicare’s rigorous application of limitations does not provide for any malfunctioning infusion set due to bent cannula or occlusion or accidentally pulling it out. IMO, Medicare is “penny-wise and pound-foolish”. Managing my diabetes under Medicare has proven quite frustrating but I am determined to stay as healthy as I can.