CVS Caremark notified me that it no longer will cover OneTouch test strips–and that I must change to Accu-Check.
You could try having your doctor write an appeal or a letter of medical necessity to the insurance company if you don’t want to switch! I’ve heard good things about the Verio though.
you should know that in most cases if they accept the Appeal, you end up paying a higher price.
@damien, the answer to your question is really quite simple, and it most probably was answered in the literature you received.
First off, “CareMart” is an health insurance company that has “teamed” with CVS for distribution of its formulary medications and supplies. Like all insurance companies “best” deals are made with manufacturers to provide best-pricing for its customers and for itself.
The real money-makers in this game are the “middlewomen” known as PBM - Pharmacy Benefit Managers.
You can always go the route of an appeal which at most will give you a one year extension, and as was said above, at possibly a higher out-of-pocket. When choosing an insurance company, it is highly advisable to check its formulary - and formularies can change, and often do at the beginning of a new policy year.
CVS did not drop Lantus; your insurer took Lantus off its preferred medications. I suspect that Lantus was replaced on the formulary with an equally effective background insulin.
I used the Accu-Chek Nano for about 2 years (was made to switch by my insurance) and hated it. My first two meters kept giving error messages. I went through several batteries and twice the number of strips I was prescribed in the first couple months. When I complained to Accu-Chek they tried to trouble shoot and then sent me a new meter and some replacement batteries and test strips. For some unknown reason the new meter worked better than the ones I got through the pharmacy, but I’m still glad I don’t have to use it anymore. (2 years after telling me to switch to either OneTouch or Accu-Chek from Precision they told me to switch to OneTouch from Accu-Chek. Go figure.)
That said, I am a fan of the Accu-Chek Fastclix lancet pen. Having 6 lancets in one really cuts down on the amount of stuff I need to carry around.
hi @damien -
Have you tried taking your One Touch Rx to another pharmacy? I suspect you are locked into using Caremart/CVS as your mail order pharmacy, but I thought I’d ask anyway.
When I had had Caremark as my mail order pharmacy, I found out my health insurance covered all my dbx supplies under the durable medical equipment (DME) provision of my health insurance coverage.
Call the insurance company, ask them what’s covered by your DME provision (name the specific diabetic supplies you use) and ask for the DME suppliers they partner with (so they are considered “in network”). Make sure you get a 3rd party provider for diabetic supplies (most DME are oxygen tanks, walkers, hospital beds, and the like - those providers don’t offer dbx supplies).
The worst thing is you’ve spent a few hours making calls. The best is, well, you pay $0 out of pocket.
DME benefit rarely has the same restrictions as the pharmacy benefit and you’ll be free to get your One Touch supplies.
I’ve fought against moving to Accu-Check for years. My endo agrees with me that it’s sub-par compared to the One-Touch.
Best of luck - let me know if you have success!
To your good health -
Nancy
I have a different coverage issue, and am hoping someone has some advice for me. I recently started using the Libre GCM, and while I really like it and find it helpful, I find I still need to finger stick about 8 times a day. I certainly don’t mind this, and it is partly because there are times when I cannot trust the Libre, for example during and after exercise. Plus, as I am starting menopause, things change ALL THE TIME, related to my hormones I am guessing. Which is why I am averaging 8 finger sticks with my verio one touch a day. My insurance company is saying they will not cover ANY Verio test strips because I am using the Libre. The Libre comes with 100 test strips for 3 months. That many test strips won’t even last me ONE month. Any advice? Can I appeal this with the insurance company? Any had any luck with this? Is there someplace I can buy cheap strips?
Thank you!
Jess
Contact Accu-Chek or the Libra manufacturer.
Ive found the trick is getting the entity which stands to gain the most financially to fight the insurance company for you. 8 strips a day is nearly 3000 strips a year, so the manufacturer stands to make thousands of dollars a year extra if they can get you coverage. Use that to your advantage. Ask them and your doctor to fight for you.
Not to play the devil’s advocate but why are you staying with the libre if you feel the readings are unreliable? Also most insurance companies send appeal forms with negative decisions. If not call their customer service number and request to start an appeal. Keep in mind the time frame to file an appeal is limited so the sooner you do this the better.
Thank you Edward. I will try this! Samantha, the reason I like the Libre and want to keep using it is that I do find it very helpful in looking at how my BS is trending, and it allows me to test much LESS than I would be otherwise. Interestingly, some sensors are much more accurate that others. The one I have on my arm now is very accurate. The previous two have been far less accurate, particularly during exercise when I need it most. And I am not talking about while my BS is changing rapidly. They often don’t reflect any change at all over the course of an hour run…
Jess
Interesting. I’ve heard of insurers changing their formularies but not pharmacies. I get mine at my local CVS and they haven’t mentioned anything andI’ve had no problems at all. Perhaps you could go to a local one instead, or switch pharmacies? If worst comes to worst check eBay. I’ve stocked up on occasion, albeit out of pocket, and have gotten some good deals on strips. Be sure to check expiration dates though.