Integrated Diabetes Services (IDS), which if you're unfamiliar with it, is an organization dedicated to coaching and management services for people with diabetes (either in-person in its suburban Philadelphia office in the Main Line town of Wynnewood, or remotely via phone or the internet, was started by CDE Gary Scheiner. Gary has been one of the most recognized CDE's in the country for many years. Anyway, his organization publishes a blog known as IDS In the News recently published a blog post entitled "'Buy-Buy' Test Strips for CGM Users" which I encourage you to read at https://integrateddiabetes.com/cms-has-stopped-covering-meters-strips-for-cgm-users/ which addressed how CMS (the Centers for Medicare and Medicaid Services, which runs Medicare and also helps states implement Medicaid, on May 13, 2022 proposed a policy (see https://www.cms.gov/files/document/cms-1738-r.pdf) whereby Medicare will no longer be covering traditional fingerstick blood glucose testing supplies (strips) for Continuous Glucose Monitor (CGM) users. That policy is now in effect. But what it portends for those covered by commercial health insurance policies is what we need to beware of.
Medicare already had fairly miserly coverage of traditional test strips, but at least they previously covered them for CGM users. Now, CMS has rescinded a previous decision to cover them. Starting January 1, 2025, CMS (the organization that administers Medicare and Medicaid) ruled that all users of FDA-approved CGM devices classified as "non-adjunctive" (not requiring fingerstick confirmation) were not eligible for coverage of fingerstick Blood Glucose (BG) monitors and test strips.
The thing is that this is not exactly what the U.S. Food and Drug Administration has determined for CGMs. Technically, CGMs are not designed to replace fingerstick testing outside of a hospital setting. That means that FDA still believes fingerstick tests are required for CGM users unless the patient is checked-in to a hospital where there are nurses around who can treat patients for hypoglycemia if the patient is unable treat a low for themself. Specifically, FDA determined that "Non-adjunctive CGM usage was for in-hospital sites, allowing BG levels to be monitored from a central nurses' station backed up with ancillary resources." However, "out-of-hospital sites usually lack ancillary resources except EMT vehicles. Ancillary resources represent 'proven workarounds'".
But more troubling (at least to me) aspect of this was the following observation IDS made about what this CMS determination will likely mean for patients who are covered by commercial healthcare insurance plans. Specifically, in the fourth paragraph, IDS wrote:
"This ruling most likely will be promulgated to all health plans."
This should terrify people. As IDS opens its article:
T1D is a numbers game. Run out of numbers, and the game is over. Diabetes, by its very nature, is an ever-changing condition, honed through experimentation – much like parachuting. Jumping with a failed main chute and no functional reserve chute is unlikely to produce anything good.
Not only is Medicare not covering strips for people who arguably need coverage of at least some test strips, but this will be a convenient excuse for people covered by employer-sponsored healthcare insurance plans to stop covering test strips for patients who use CGMs as well.
Now, while the CMS policy is already now in place (unless that failed policy is rescinded, which it should be) it has not (yet) been adopted by commercial healthcare insurance plans, but it is safe to assume that it will be as soon as United Healthcare, Cigna and Aetna can do so. That is, unless we intervene. And we must!
IDS recommends that you immediately contact your Congressman/woman and both of your Senators to withdraw this errant policy issue, cancel, correct, revise [or burn] this CMS ruling 1738-r in order to restore Blood Glucose Meter (BGM) coverage and test strips when using a non-adjunctive CGM for out-of-hospital settings so we can all rest easier at 03:00 AM.
In the interim, for anyone adversely impacted by this CMS policy, my recommendation is as follows. Since November 14, 2022, Mark Cuban Cost Plus Drug Company has sold Roche Accu-Chek testing supplies at cost plus a markup of 15% and a distribution fee. I blogged about how my insurance company recently notified me it was switching to Accu-Chek as its "preferred" test strip brand in a recent blog post found at https://blog.sstrumello.com/2025/05/cvs-caremarks-preferred-brand-switch.html. I also blogged about how I recommend people choose the Accu-Chek "Guide" meter which is slightly more expensive than the "Guide Me" meter, but features a lighted test strip port & backlit display instead of guidance of what the meter readings mean, which is far more helpful for newly-diagnosed patients than a lighted test strip port.
The Mark Cuban Cost Plus Drug Company cost for a package of 50 test strips is currently $18.79, or $0.38 per test strip. That's not the least costly which can be found anywhere, but it's also not excessively overpriced as retail prices for testing supplies so often are. Those prices are available via its mail-order (and there is no maximum quantity even while the website has a maximum of 3 vials of 50 strips, if you doctor prescribes more for you, they will mail you more. Also, know about something called the Team Cuban Card which enables patients to visit local pharmacies affiliated with Mark Cuban Cost Plus Drug Company (most are based in big supermarket chains which still operate pharmacies in-store). That's an option where you can take a printed prescription in-store and pick the supplies up at a local pharmacy and receive the Mark Cuban Cost Plus Drug Company price.