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Please Help to Change Medicare's Policies on Diabetes Care


I'm Max Morneault, a 27 year old man diagnosed with type one diabetes in 1997. Type 1 is a form of diabetes caused by an autoimmune disorder, and has no cure. I was determined to be disabled for psychiatric reasons in 2010, at which point Medicare became my health insurance.

Medicare has a manual describing what drugs are covered, and what services I can get as a patient. One portion essentially says that my care is between me and my doctor, so if my health depends on having a certain script or therapy, I can get it. This ends up well enough until it comes time to get my diabetes testing supplies;

Having been diagnosed in 1997, I thought my condition of type one diabetes had been established when I developed ketoacidosis at 10 years of age. I discovered when I needed to get more supplies for my insulin pump and glucometer that Medicare wouldn't pay for them because I hadn't proven my diagnosis of diabetes, despite clinical assertions that I did. My illness could only be determined by a C-peptide test - this test must be done while fasting, and one's glucose can't be above 210 or the results are worthless. It basically demonstrates that the body produces a certain amount of a peptide that's made in a direct ratio to insulin. After taking that test for the third time, I finally had a fasting glucose below 210 and my results showed I could get my supplies.

My dilemma at that time (and currently) was that insulin dependant patients are initially allowed 3 test strips per day (non-insulin dependant getting 1 per day), and to get more the patient's doctor must fill out a form detailing the medical necessity of more tests, as well as the patient filling out a test log for 28 days demonstrating that the tests are actually being done. I literally need to prove I'm checking my bloodsugar - a ridiculous request (considering self monitoring is impossible without numbers), but not one that's impossible to comply with.

Knowing I can only test my glucose 3 times per day, I fill out a log showing most days have me test about that much, only to find out that Medicare isn't looking for what my glucose is. They want me testing 8 times per day, regardless of the numbers. In spite of my readings clearly showing that I need to test more than 3 times per day, with my average being somewhere around 275, I can only get more test strips by showing I've used about 224 test strips in a month, leaving me with 76 to get me through the next two if something goes wrong with my log. And, six months after I send in my test log, I need to send another one to continue getting supplies. This will continue for as long as I have medicare.

The American Diabetes Association recommends at least 6 tests per day, and endocrinologists across the board suggest at least that many tests per day. Medicare says people with diabetes only need 3.

I understand that this policy probably emerged to cut cost and fraud, and a rather obvious cost cutting measure is to put a cap on testing supplies. The problem is that this doesn't stop fraud, considering the glucose readings aren't considered - just the frequency of testing. A patient could easily falsify their test log in order to get more test strips than they actually need, provided the proper script was written by an unscrupulous doctor.

Another method to cut cost is to ensure that people with diabetes are able to test as frequently as they need to and thereby reduce the costs associated with complications as a result of tighter control. This illness costs hundreds of billions of dollars each year in the US, and if the first thought to reduce the cost of the disease is to increase the risk of diabetic complications (which include heart disease, stroke, and neuropathy), something's gone wrong.

People living with diabetes shouldn't be at the whims of any health insurance company to get required, and often life-sustaining medication and supplies. That the standards of care for diabetes are below medically recognized minimums says a lot about how informed the policy makers behind the decision are. Immediate cuts to cost like this fall far short of a long term solution to medical spending - Diabetes is well on its way to becoming the most expensive disease in the country. The only way to curb this trend is to ensure that patients are able to test as often as they need to, without fear they'll run out of supplies.

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