Physician outrage over CVS’ new diabetic testing policy

diabetes, glucose monitoring, diabetic testing supplies, Medicare, CVS Pharmacy

Physician outrage over CVS’ new diabetic testing policy

https://www.physicianspractice.com/patients/physician-outrage-over-cvs-new-diabetic-testing-policy

Editor’s Note: Physicians Practice’s blog features contributions from members of the medical community. The opinions expressed are that of the writers and do not necessarily reflect the opinions of Physicians Practice or its publisher.

 

Self-monitoring of blood glucose is an essential part of managing diabetes. It is both a necessary practice for those who adjust their insulin based on their glucose levels and an educational tool for patients who want to know what happens if/when they eat three slices of pizza instead of a salad for dinner.

Monitoring glucose is also a kind of safety precaution. Patients with diabetes who feel weak or dizzy are instructed to check their glucose to make sure it’s not too low. Glucose monitoring is so important for diabetes management that Medicare will pay for one test strip per day for patients who have diabetes and are only taking oral agents. Medicare will pay for three test strips per day for those on insulin. Beyond that, Medicare will cover more if there is a documented need, such as episodes of hypoglycemia or for medication adjustment.

However, I learned several local CVS pharmacies and endocrinologists in other states that CVS as a company has decided it will not dispense more than Medicare’s basic allowance, one if on pills and three if on insulin. I was told that is all they will dispense regardless of what a physician prescribes or any circumstances that may justify more frequent testing.

I believe this is tantamount to practicing medicine without a license. I could not believe that a pharmacy would take it upon itself to decide what is appropriate testing for patients.

Physicians Practice reached out to CVS for comment (see below). CVS confirmed it has decided to restrict patients to the number of strips covered under Medicare’s “standard utilization guidelines.” For those who have been prescribed more than the ‘standard,’ CVS is asking for new prescriptions that meet such guidelines. The company makes no mention of accommodations for patients with legitimate reasons to check more often nor does the company mention that Medicare makes exceptions for patients with documented reasons for more frequent testing.

I was so incredulous at this new development and so upset on behalf on my patients that I wrote two my state representatives and state senator. My state senator’s chief of staff reached out to me, and he is also going to contact CVS. I’m waiting for his reply. I also wrote to our local paper. The deafening silence has me even more perturbed. To me, this is an emergency. What are patients who need these supplies supposed to do?

To make sure this wasn’t a change in Medicare’s policy I was unaware of, I also called a local Walgreens to find out if they have similar protocol. I was told no—it’s business as usual. However, Walgreens sends physicians a form asking for a diagnosis code and for a reason for more frequent testing, if applicable.

Some colleagues have tried to talk me off the edge. They tell me patients can get their supplies cheaper on Amazon. While some patients can go to different pharmacies, some payer plans require them to go to specific pharmacies. And yes, patients can also use a durable medical equipment supplier.

But I don’t think patients should have to seek care elsewhere or potentially pay out of pocket because their pharmacy refused to fill a prescription that a physician wrote and the payer authorized.

It’s bad enough that decisions are made by non-medical people at payers or insurance companies, which are more concerned about profit than patients. This is unacceptable, and we must draw a line.

If we allow CVS to make this decision on behalf of physicians and our patients, then where does this end? What else can pharmacies restrict? Will pharmacies now dictate what our patients can and cannot have?

If so, the healthcare system is even more broken than I thought.

Melissa Young, MD, FACE, FACP, is sole owner and solo practitioner at Mid Atlantic Diabetes and Endocrinology Associates, LLC. As such, she is both actively involved in patient care and practice management while also raising two kids and a dog in suburban New Jersey

 


Editor’s Note: Physicians Practice reached out to CVS Pharmacy for comment. The company shared the following statement:

“CVS Pharmacy is committed to supporting the health needs of patients who have diabetes while also complying with applicable requirements and guidelines. Effective January 29, 2019, CVS Pharmacy limits quantities of diabetic testing supplies (DTS) covered under Medicare Part B to Medicare’s standard utilization guidelines in order to meet Medicare’s medical necessity requirements. 

“Under these guidelines, CVS will dispense DTS – including diabetic test strips and lancets – to non-insulin dependent Medicare Part B patients for testing no more than once per day; and to insulin dependent Medicare Part B patients for testing no more than three times per day.

“In the lead up to the January 29 effective date, we contacted our diabetic Medicare Part B patients, and their prescribers, who have previously filled a DTS prescription at CVS Pharmacy to inform them of our adherence to Medicare’s standard utilization guidelines. Medicare Part B patients with current DTS prescriptions that exceed the guidelines will require a new prescription that meets Medicare’s standard utilization.”

Could it be that CVS doesn’t want to spend the “extra time” to get bills processed thru the Part B system to justify extra glucose tests/day that the pt needs ?

Years ago I met a young woman who was required 10 insulin shots a day while she was pregnant (gestational diabetes).  CVS keeps promoting that they are transitioning the company into more of a provider of health, but this article seem to suggest that their idea of “health” is by conforming to some “cookie cutter formula” ?

 

10 Responses

  1. This is the same practice that is occurring with opiates. The government and pharmacists need to stay in their perspective lanes and not practice medicine.

  2. “cookie cutter formula” for health…

    why not? that’s exactly what they’re doing to CPPs –the mandated reductions to the “guidelines.” tho some docs are ahead of the curve; I’ve been well below the 90 mme for years, but am being tapered anyway. Why? Beats me; it sho ain’t my idea.

  3. I would expect this is probably more about them wanting to reduce their losses as third party payors take back payments for improper documentation of day supply orders that are outside of the normal limits, an increased difficulty in documenting payment for orders outside of the guidelines or a failure by the medicinal community to properly submit orders which comply with third party standards (which are practically impossible to comply with every varying plan). Otherwise I do not understand why CVS would propose a plan to limit what they can sell at their pharmacies unless I have misunderstood the article and this is really a policy of CVS Caremark, the third party PBM side of their business. These are two sides of the business with varying motivating factors and potential conflicts.

  4. Another step closer to socialized medicine. This is an example of what we will see if we go to socialized medicine. The government and profit pharmacies will start making decisions on out medical needs that have no license or understanding our real medical needs. Our bodies are not a one size fits all. Please everyone, understand if the government cant run the VA, DMV, post office (that loses large money everyday) why would you want it. Just because some other countries run a successful socialize healthcare system doesn’t mean our country is going to do it. I don’t want to put my faith into a government healthcare system where I am considered a burden on healthcare funds and it would be cheaper if I was dead than to treat me.

  5. It seems that “guidelines” have become a license for furthering one’s agenda or bottom line. There is no mandate to “comply” with a guideline or penalty for failure to do so. A guideline is a suggestion only, and never applies universally. This is just plain greed couched in “compliance”.

  6. One reason why I never use CVS for anything. I would love to see them close down

  7. I am a chronic pain patient caught in the opioid crisis. This is nothing new to us! I have CRPS/RSD, the most painful disease known to man. Welcome to my world. Only, mine is much worse than this.

  8. I’ve been wondering when they’ll start legislating how much insulin a diabetic can get, a la dictating the dosage of pain meds for pain patients (the 90 MME). After all– insulin is abused by dieters, bodybuilders, & weightlifters!

    Bet this is the first step.

    • My husband is on insulin and we have to use CVS Caremark. We never got a letter from them about this! We are both Chronic Pain Patients and CVS decides our pain medication amounts over the script our doctor writes. It is a constant battle between our dr. and the pharmacists at CVS who think they are drs. They wanted $230 for 23 days worth of insulin. We’ still trying to sort that out and he’ll die without it.

Leave a Reply

%d bloggers like this: