Archive for August 13th, 2013
Ongoing changes in the way insurance companies cover the costs of durable medical equipment (DME) may affect how insulin pump patients get diabetes testing supplies. Getting and using the correct testing strip, in particular, is important to the operation of insulin pumps. The needed strips may still be covered by insurance, but the new rules may assign a higher copay to these supplies or change where and how strips can be purchased.
A drug copay is the patient’s share of the cost of a drug or DME. The remaining cost is paid by the health plan or insurance company.
Periodically, insurance companies make revisions to their prescription drug programs that may involve excluding certain drugs/DME or shifting items between tiers (i.e. from a lower copay to a higher copay, or vice versa). These changes are often in response to the availability of lower cost alternatives, such as generic or over-the-counter drugs, or a change in the pricing contract with manufacturers.
Most insurance plans have “tiered copayment levels.” With tiered copays, each drug or needed item is in one of several levels. And there’s a different copayment for each level.
- Tier-one prescription items may include low-cost generics
- Tier-two prescription items may include higher-cost generics and lower-cost brand drugs/DME
- Tier-three prescription items may include higher-cost brand drugs/DME
- Tier-four prescription drugs may include much higher-cost medications – such as some cancer drugs – and instead of a copay, you may pay a percentage of the actual cost of the drug or item
Diabetes Management & Supplies is aware of these changes, and our staff stands ready to assist our insulin pump customers in making sure they continue to get the most appropriate strips for their insulin pumps. If you are having difficulty navigating these changes or if you have questions about the use of your pump or its accessories, call our Insulin Pump Info Line at 1-888-738-7929.
DMS offers a wide range of insulin pumps and accessories. Visit our Product Directory to view available devices and supplies.
DMS also offers insulin pump training and accredited diabetes education services. For more information on specific insulin pump needs or to enroll in group or individual sessions, call our Education Department at 1-888-738-7929 or email an educator at firstname.lastname@example.org.