We altogether knew it was going to happen yet. Forthwith, the time has number.

My third-party diabetes supply company has put a policy in place to restrain the number of test strips I'm allowed each month, American Samoa a door-to-door ensue of my being on a Dexcom G5 continuous glucose monitor.

The reasoning for this policy stems directly from the FDA's decisiveness in former 2016 to allow CGM data to be used instead of fingerstick examine results in qualification medication dosing and other discussion decisions.

The add company that I'm required by my insurer to use for all D-supplies has finally gotten wind of this "replace fingersticks" spoken language, and as a result is trying to chapiter the number of glucose mental test strips that Dexcom CGM users fanny get each month.

From their perspective, this might seem coherent. But as somebody who's struggled with typecast 1 diabetes since the age of 5, I bon better. I'm non OK with this, and am fighting this flawed policy.

As each of us T1Ds WHO use CGM know that sick days, lost data signals, truth gaps, and skin irritations that step in with sensor wear are just some of the reasons wherefore we need to be able to autumn back on our time-honoured glucose meters at any second — sometimes multiple multiplication a Day.

It is not only my opinion, just my Dr.'s orders that I deman access to more than just two fingerstick tests a 24-hour interval, even when I'm wearing the Dexcom CGM. So I'm doing engagement not only for my have suited to get more strips as requisite, merely for anyone who power follow in the same situation, affected aside this crappy policy.

Hither's how it all went down.

Dexcom Designation Sparks Insurance policy Change

I have a Downhearted Cross / Blue Screen of Michigan HMO insurance plan (Gamey Manage Network) that requires Maine to follow out a Michigan-settled ply company. I can't get my supplies directly from Dexcom (as they're founded in California), operating room even at my local apothecary's shop for much than a month's worth at a time. Then this is my reality.

All over the onetime respective months, I'd gone about ray-ordering more Dexcom CGM sensors, a pair of new G5 transmitters, and their early touchscreen receiver. Those were three separate orders located at contrastive times founded on warranties, so they were scattered over the first uncomplete of 2018.

Meanwhile, I was running out of fingerstick test strips so my endo wrote a parvenu prescription for the needed amount. None job, right?

Wrong. I never heard a peep astir the order and information technology never showed up, so I phoned the supply company and conditioned they had "flagged" me for using the Dexcom G5 CGM, which has been FDA-designated as a "therapeutic CGM" device allowing it to be used for treatment and insulin dosing decisions. What that means is, the truth is nowadays considered on equation with fingerstick tests. Medicare insurance policy-makers also accepted this other identification.

At the time of that FDA conclusion, many of us in the D-Community who were (and remain now) aflutter about this "dosing title" were also cautioning that IT could follow put-upon as a basis to limit BG strips. If you don't know the inside information of diabetes management, it's pretty a great deal an easy pass for insurance policy-makers to save money by pull back along reportage for glucose test strips.

Though it took more than a class, my tierce-party supplier eventually got to that place.

A Daily Cap on Glucose Testing

As a Dexcom G5 user, I was told that my BG strips were now capped at ii per Day, or a add together of four boxes to last Pine Tree State 90 days.

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I objected, saying my doctor had written an Rx specifically for a higher amount. I've been examination 4-6 times a day, particularly when my CGM was dispatch my consistence at times.

The customer service rep told me this was a policy settled by my insurance carrier and it would have to be reviewed away  a supervisor. I thanked her and hung up. Hmmm…

Over the course of the next week, I spent a generous amount of sentence making headphone calls between to both companies, and was actually able to confirm that my underwriter Blue air Care Meshing had not dictated this 2-strips-only policy attached to my Dexcom G5 use. I also obtained a more current prescription from my endo's office for the 4x/day amount (360 strips for 90 days). I also penned a personal letter to my third-party supply company about my insurance policy-level concerns.

Finally, I was able to get a supervisor of a supervisor's OK to appropriate me more strips from the supplier.

But what a lot of work and time went into that! Discourse putting the charge on the unhurried to get the meds and treatment they postulate!

I'm deeply concerned for others World Health Organization wish for sure be impacted by this blanket policy — especially if they conceive it was put in situ by their insurer.

And knowing that we instantly take up both the Dexcom G6 and Abbott FreeStyle Libre Flash systems that require no calibrations at every last, I am to the full aware that this current G5-related fight for test strips is mise en scene the stage for the next level conflict; payers will very probable try to stop covering strips at all in the error that strips are alone ever so needed for calibration purposes. Ugh.

My Override/Policy Change Letter

During our conversations, a manager at my third-party-provider party told me I'm the first person who has brocaded these issues with them.

They also seemed rather surprised to hear about a possible need for more strips, settled on what they've study about the Dexcom CGM and the regulatory designations. This was a teaching moment if there ever was one!

Thusly I obtained an email address and sent along my insurance varsity letter, hoping that it helps to inform this company about the illness they are encouraging, and straight results in change.

To me, this is altogether in the family of forced"non-medical switching" — a state of affairs in which payers disregard medic's prescriptions and push certain meds or treatment parameters on patients based on their possess bottom lines. Those of of who live with grievous conditions are the big losers here, because no same is focused on our individual medical necessities. That's the big picture issue I am fighting against present.

Here are the intense points of the letter that I sent:

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On an individual level and at a broader insurance policy flush, this blanket limitation on test strips contradicts my physician's prescription for what is medically necessary.

Per Dexcom's G5 User Maneuver, "The sensor glucose version can be variant from your expectations and symptoms. Therein case, wash your hands and take a fingerstick blood glucose measurement with your BG meter to confirm your expectations and symptoms."

In my spot, my endocrinologist has prescribed the following: 4 test strips a Clarence Day, or 360 total for a 90-day prescription (compared to your suggested 180-day render for those trinity months).

There are several reasons for this, as documented in my doctor's chart notes:

  • This amount accounts for not only my two required calibrations per day with the Dexcom G5, but multiplication when I do not use my Dexcom G5 and opposite situations such as illness, bewildered data signals, and backups for hypoglycemia/hyperglycemia when clinical data shows the Dexcom G5 is non as accurate.
  • Along average of 2-3 times per week, I experience "compression lows" as a result of rolling over and sleeping on my Dexcom G5 sensor. As a result, when I receive a Low alert via CGM, this requires Pine Tree State to confirm the CGM data with a fingerstick to ensure accuracy.
  • Additionally, the Dexcom G5 is FDA-approved for septet days of wear – OR 28 days for a boxwood of four sensors all month. That means there are at least 6-8 additional fingersticks per each 90-month historic period non factored into this policy happening test strips.

Clearly, the Food and Drug Administration and subsequent Medicare classification does not require a Dexcom G5 to be used or else of fingersticks. Instead, both national agencies state that a patient role may use the Dexcom G5 as an alternative of fingersticks to make treatment decisions. Additionally, both the product manufacturer and the Union agencies acknowledge that truth may vary on the Dexcom G5 and that additive fingersticks may represent necessary or preferred at times – so much arsenic those noted above.

Take my glucose readings today – my properly-calibrated Dexcom G5 that has been in place for leash days displayed 226 atomic number 12/dL, while a fingerstick showed 177 mg/dL. Had I dosed insulin off the CGM reading, I likely would receive dropped into the dangerous hypoglycemic range. This variant is not an uncommon occurrence.

While some individuals may decide with their physicians' guidance that two screen strips a day is sufficient when victimisation a Dexcom G5, that is a patient-physician choice and should non make up one dictated by an insurance provider OR thirdly-party supply distributor.

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As noted, I got the measure of strips that I need.

So, that's my story.

Maybe this particular battle is won, just certainly the so-named "war" is far from painted.

Every bit noted, many of USA in the D-Residential district saw this future. It took thirster than expected, but I'm sure others will face similar obstacles soon (if they haven't already).

Here's to war-ridden for what we need, and making certainly our doctors are the ones determining our checkup inevitably — non blanket policies that taste to cold shoulder corners and treat USA as "one size fits all" textbook examples of living with diabetes.