Information for consumers about resources for diabetes testing supplies

• Does Medicare cover diabetes testing supplies? Yes!
• Does Medicaid cover diabetes testing supplies? Yes!
• Do private and managed care health insurance plans cover diabetes testing supplies? Yes, most do!
• Are there resources for diabetes testing supplies if I do not have insurance or my insurance plan does not include coverage of supplies? Yes!

Does Medicare cover diabetes testing supplies? Yes!

Medicare now covers blood sugar monitors, test strips, and lancets for all Medicare Part B enrollees with diabetes. There are limits on the number of test strips and lancets per month. We've listed the current limits, but you should ask a pharmacy or Durable Medical Equipment Regional Carrier that is enrolled in the Medicare program for the most recent information. Currently, people with diabetes who use insulin are eligible for 100 test strips and 100 lancets every month. Medicare will pay for more per month if the physician documents the beneficiary's need to test blood sugars more often. People with diabetes who do not use insulin are eligible for 100 strips and 100 lancets every two months. Medicare will pay for more per month for non-insulin-treated beneficiaries if one of the following indicators is present: (1) Management of medical condition by adjusting therapy and/or medications; or (2) Detection of low blood sugar when symptoms are present.

The annual $100 deductible and 20% co-payment still apply to the purchase of diabetes supplies. Ask your pharmacy or supplier if it is enrolled in the Medicare program prior to purchasing your diabetes supplies. Pharmacies that are enrolled in Medicare will only ask you to pay your portion of the bill and will then bill Medicare directly for the other portion. If you go to a pharmacy or supplier that is not enrolled, you would be responsible for paying the entire bill upfront. The pharmacy will then help file the Medicare claim for you to be reimbursed. Also, do not accept automatic shipments of diabetes supplies that you did not ask for.

For more information, visit the Medicare Diabetes Health Information website at:
http://www.medicare.gov/Health/Diabetes.asp.

Does Medicaid cover diabetes testing supplies? Yes!

All enrollees with diabetes are eligible for coverage of blood sugar monitors and test strips, including both those who use insulin and those who do not. Pregnant women with gestational diabetes can also receive coverage of testing supplies. Medicaid also pays for insulin syringes if you need them. You will need prescriptions from your physician. The number of test strips covered each month is limited. Also, you will need to find a pharmacy that is registered with a special section of Medicaid and is eligible to bill Medicaid for supplies. By using a Medicaid registered pharmacy, you will receive coverage for both test strips and insulin syringes.

Your questions can best be answered by the CARE-LINE, the information service provided by the Office of Citizen Services of the North Carolina Department of Health and Human Services. You can call them toll free at 1-800-662-7030, or e-mail them at care.line@ncmail.net. More information is also available on the Office of Citizen Services CARE-LINE website: http://www.nccareline.org.

You may also want to refer to the North Carolina Division of Medical Assistance's Information for Medicaid Consumers website:
http://www.dhhs.state.nc.us/dma/consinfo.htm.

Do private and managed care health insurance plans cover diabetes testing supplies? Yes, most do!

In 1997, the North Carolina legislature passed House Bill 5 that mandated insurance plans, managed care and health maintenance organizations governed by the North Carolina Department of Insurance to include benefits for blood sugar testing supplies. Deductibles and co-pays often still apply to coverage of testing supplies. However, some insurance and managed care plans will waive these fees for both diabetes medicines and testing supplies if you participate in the organization's diabetes management program. Participating will not only possibly qualify you for waivers of fees, but will also increase your knowledge and control over diabetes. Contact your health plan to determine if this benefit is available to you.

Are there resources for diabetes testing supplies if I do not have insurance or my insurance plan does not include coverage of supplies? Yes!

Currently, no pharmaceutical company offers a financial assistance program for testing supplies. We offer resources and suggestions to help make testing supplies more affordable. Please also refer to the Diabetes Resources Page .

Generic supplies

Ask your physician for advice on the best generic meter available and ask them to check the accuracy of your meter at the clinic. Although you can get brand-name monitors for free or a reduced price, the brand name strips are twice as expensive as the generic strips.

Clinics with reduced price brand name strips

University of North Carolina clinics: You must see a UNC physician and buy your medications and diabetes supplies at the UNC pharmacy. A sliding-scale based on financial need is used to determine your co-pay for all medicines and supplies. You can contact the pharmacy assistance program for more information at 919-843-0807 or 919-843-0808.

Community Health Clinics - Gaston Family Health Services in Gastonia (704-853-5261), Piedmont Health Services - Carrboro, Moncure, Prospect Hill, and Charles Drew in Burlington (919-933-8494), and Metrolina Comprehensive Health Center in Charlotte (704-393-7720): You must see a physician at one of these clinics and buy your medications and supplies from their pharmacy. All of the medications and supplies are offered at a substantially reduced price (for example, usually one type of brand-name monitor and test strips are sold at a similar price to generic monitors and test strips).

Contact information for all of the Community Health Clinics can be found at the North Carolina Primary Health Care Association website, www.ncphca.org. Click on "for consumers" then "community health centers in North Carolina".

Albemarle Regional Health Services: In combination with other community partners, a free clinic in Elizabeth City is offered every Wednesday to those with low incomes. If you are seen at that clinic, you may then be eligible for financial assistance to buy your medications and diabetes supplies. Contact the Diabetes Department at 252-338-4370 for more information.

Open Door Clinic in Raleigh: If you are a resident of Wake county, have no health insurance, and are below 185% of the federal poverty level, you may be eligible to receive medical care and assistance with medications and testing supplies through the Open Door Clinic. Contact the clinic at 919-832-0820 for more information.

Clinics and research studies with free diabetes testing supplies

ACCORD (Action to Control Cardiovascular Risk in Diabetes) study at Duke University Medical Center: If you have type 2 diabetes and are at least 40 years of age with a history of previous heart problems (such as stroke, heart attack, abnormal stress test or heart surgery) or if you are at least 55 years of age with or without a history of heart problems, you may be eligible for a study regarding the relationship between diabetes and heart disease. For up to 8 years, qualified participants will receive at no cost: diabetes medications, cholesterol and high blood pressure medications, and diabetes meter and test strips. Contact Mary Furst, RN, CDE at 919-681-3574 for more information.