Viewer Betty Fischer said she took her doctor's prescription to get four diabetic test strips a day to a CVS Pharmacy in White Plains, Maryland.
But CVS pharmacists told her they would only supply her one strip a day. So she asked the Verify team: does Medicare only cover one test strip a day if you are not on insulin?
First we checked with the Centers for Medicare & Medicaid Services about their coverage policy.
Medicare Part B patients are covered for 100 strips a month. If you're not on insulin, you're covered for 100 strips every three months.
But you can get more with the right kind of medical documentation.
We then spoke with a CVS Health spokesperson who said the pharmacy follows those Medicare guidelines, but they won't hand out those extra strips.
CVS sent the following statement to Verify researchers:
CVS Pharmacy is committed to supporting the health needs of patients who have diabetes while also complying with applicable requirements and guidelines. We abide by Medicare’s standard utilization guidelines for diabetic testing supplies (DTS) dispensed to Medicare Part B patients in order to meet Medicare's medical necessity requirements: once per day for non-insulin dependent Medicare Part B patients and up to three times per day for insulin dependent Medicare Part B patients. Failure to abide by these requirements jeopardizes our ability to continue to service the hundreds of thousands of seniors who rely on our pharmacy services through Medicare.
We recently worked through our trade association, the National Association of Chain Drug Stores (NACDS), to make recommendations to the Centers for Medicare & Medicaid Services (CMS) to revise its DTS dispensing policy and requirements. Specifically, CMS requires that pharmacies produce physician medical records during claim reviews, when DTS are dispensed in quantities that exceed Medicare’s standard utilization guidelines. Yet the pharmacy has no window into knowing, at the time of dispensing, whether extensive CMS requirements that are imposed on physicians, to justify the additional supplies, are complete in the patient’s medical record.
That's because the pharmacists don't have access to those medical documents we just mentioned.So no medical documents on hand, no extra strips.
But as for Medicare paying for only test strip a day if you are not on insulin -- we verified that's false. Betty got her additional diabetic strips from Giant Pharmacy, that doesn't follow the same CVS protocol.
