Insurance

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Permalink Reply by Shelly Largent on October 24, 2008 at 4:29pm

I had the same problem with my insurance as well. Depending on how your endo / doctor wrote the prescription for your test strips, your insurance will only allow for that many strips per month, no more. You can talk with endo / doctor and explain that you need more strips, talk to them about your routine and your doctor can bump up the prescription. That's what I had to do with my insurance. I was testind about 4 times daily (which comes out to about 125 strips allowed per month). When I was put on my insulin pump 3 years ago, I had to have my test strips bumped up to 200 strips because I test more often with the pump. My insurance had no problem with the "new" prescription..... I have PacifiCare HMO if that helps any.....

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Permalink Reply by Christina Luis on November 29, 2008 at 12:06pm

We have SiscII ( Blue Sheild PPO) we have had a similar issue with drugs. We have worked with our mail pharm to refil asap (with their refill date) other than that you would need to have the dr either call or write a new script with an allowance for more testing. with my daughter they called and asked how often she would be testing. I told them at least 4 x a day or as needed. They sent a ton of strips. Have you tried calling the ins. co? Maybe they could allow you to fill early. I would just tell them that you are diabetic and not testing could mean a trip to the hospital? Whats a Formulary?

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Permalink Reply by Teresa on December 9, 2008 at 2:50pm

Hi! As I understand it, a Formulary is a list of medications or medical equipment that an insurance company has approved for coverage. Generally, if it's not on the formulary it won't be covered by the insurance company and must be paid for out-of-pocket. Some companies will allow a doctor to override the formulary, if the medication is determined to be "medically necessary". Hope that helps.

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Permalink Reply by Jackie on December 9, 2008 at 12:17pm

I ran into that when I was testing alot after starting Byetta. I had my doctor write me a new prescription and indicate that I had to test 6 to 8 times a day due to the new medication. I am on Blue Cross Federal.

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Permalink Reply by Teresa on December 9, 2008 at 2:45pm

Yes, I've been told I couldn't refill my prescription because it was too early. I have Kaiser. When I've been exceptionally ill and used alot more strips than normal or, one time, spilled a bottle of strips into a sink full of water, I needed to refill sooner that I typically would. The reason I was told I couldn't refill - yet, was.... the doctor had prescribed a particular number of strips based upon my average daily use for a 90 day period. I couldn't refill until within 30 days of that 90 day timeframe. Apparently, I'd tried to refill before the 30-day period. As I recall, after explaing my situations, the good people at the pharmacy contacted the doctor's office and got exceptions to refill.

Also, many years ago when I began testing more frequently on a regular basis I hadn't thought to let my doctor know. Once I told her what I was doing and why, she was all for it and immediately rewrote the Rx for more strips.

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Permalink Reply by Gus Pearson on December 6, 2009 at 2:43pm

If you have all your prescriptions filled at the same pharmacy they have to push it through with your Doctor adding his authority to the list. Also if the Blue Shield allows your other meds, they HAVE to take the increase in strips. I used to be on Blue Cross in the late 90s and didn't have a problem at that time.

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