Letter Abut Limiting My BG Test Strips

My third-party supplier has recently tried to limit test strips for those using a Dexcom CGM system. In fighting this policy, I penned this letter. While I've been able to get more strips as prescribed, my hope is also that this letter leads to deeper consideration at the policy level by this Michigan company.

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August 6, 2018

Michael W. Hoskins

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J&B Medical Supply

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Wixom, MI 48393

Dear ------- and J&B Medical Supply:

I am writing this in response to recent letters received from J&B Medical starting on July 24, 2018, regarding the allowable amount of glucose test strips for those who also use the Dexcom G5 continuous glucose monitor (CGM) as part of their diabetes management.

Per your letter, “all regular diabetic testing supplies are included in the coverage of your Dexcom G5 sensor.” And further, due to the Dexcom G5 being classified as a non-adjunctive therapeutic CGM that can be used for treatment decisions, J&B Medical has decided on a policy level to only ship a maximum of 4 boxes of test strips for every 90 days in order to calibrate the CGM twice a day.

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

Per Dexcom’s G5 User Guide, “The sensor glucose reading can be different from your expectations and symptoms. In this case, wash your hands and take a fingerstick blood glucose measurement with your BG meter to confirm your expectations and symptoms.”

In my situation, my endocrinologist has prescribed the following: 4 test strips a day, or 360 total for a 90-day prescription (compared to your suggested 180-day supply for those three months).

There are several reasons for this, as documented in my physician’s chart notes:

• This amount accounts for not only my two required calibrations per day with the Dexcom G5, but times when I do not use my Dexcom G5 and other situations such as illness, lost data signals, and backups for hypoglycemia/hyperglycemia when clinical data shows the Dexcom G5 is not as accurate.
• On 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 me to confirm the CGM data with a fingerstick to ensure accuracy.
• Additionally, the Dexcom G5 is FDA-approved for seven days of wear – or 28 days for a box of four sensors each month. That means there are at least 6-8 additional fingersticks per each 90-month period not factored into this J&B policy on test strips.

Clearly, the FDA and subsequent Medicare classification does not require a Dexcom G5 to be used instead of fingersticks. Instead, both federal agencies state that a patient may use the Dexcom G5 instead of fingersticks to make treatment decisions. Additionally, both the product manufacturer and the federal agencies recognize that accuracy may vary on the Dexcom G5 and that additional fingersticks may be necessary or preferred at times – such as those noted above.

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

While some individuals may decide with their physicians’ guidance that two test strips a day is sufficient when using a Dexcom G5, that is a patient-physician choice and should not be one dictated by an insurance provider or third-party supply distributor.

In speaking with Blue Care Network of Michigan during the week of July 30, the insurer verified that my coverage includes both the Dexcom G5 CGM as well as any additional test strips for fingersticks that my physician determines is medically necessary; as long as a Prior Authorization is obtained, the coverage is provided.

I am sending this response letter to J&B Medical to have on file. Along with any submitted prescription and additional physician notes on file, I trust the Prior Authorization for test strips will follow what has been determined to be medically necessary – for my own diabetes care, as well as others who may also be using these products for their own healthcare.

Thank you,

Michael W. Hoskins