DME& Freestyle Libre: What you need to know
For people living with diabetes, monitoring blood sugar levels is an essential part of their daily routine. It allows them to manage their condition and avoid potential complications. Traditional glucose monitoring methods involve finger sticks, which can be painful and inconvenient. However, thanks to advances in technology, people with diabetes can now use continuous glucose monitoring systems (CGMs) such as the Freestyle Libre to track their blood sugar levels.
The Freestyle Libre is a popular CGM device that uses a small sensor placed on the back of the upper arm to monitor blood sugar levels. The sensor measures glucose levels in the interstitial fluid, providing readings every minute, which can be viewed on a handheld reader or a smartphone app. This technology has revolutionized diabetes management, providing real-time data and insights that can help people make informed decisions about their health.
Durable Medical Equipment (DME) and Freestyle Libre
The Freestyle Libre is considered a DME and is covered by Medicare Part B if deemed medically necessary by a prescribing doctor for home use. DME is defined as medical equipment that is "durable (long-lasting), used for a medical reason, able to withstand repeated use, and generally not useful to someone who isn't sick or injured." Examples of DME include walkers, hospital beds, and CPAP machines.
Medicare covers DME if it is considered medically necessary for the treatment of a medical condition, and if the supplier is enrolled in Medicare. However, recent reports suggest that some major pharmacies, including CVS and Walgreens, are not considered DME vendors and therefore will not submit claims to Medicare for reimbursement. This means that people with diabetes who rely on the Freestyle Libre to manage their condition may have to pay out of pocket and then submit a reimbursement claim to Medicare, which can be a time-consuming and complicated process.
What You Need to Do
If you are a Medicare beneficiary who uses the Freestyle Libre, it's important to ensure that your prescribing doctor deems it medically necessary for home use and sends the script to a DME supplier on the Medicare-approved list. It's also essential to confirm that the supplier is enrolled in Medicare and participates in the Medicare assignment program. This program requires participating suppliers to accept Medicare's approved amount as payment in full, and the beneficiary is only responsible for the deductible and coinsurance.
Suppliers who are not enrolled in Medicare or do not participate in the assignment program may charge more than the Medicare-approved amount, leaving the beneficiary with a higher out-of-pocket expense. Additionally, Medicare will not pay claims for doctors or suppliers who are not enrolled in Medicare, which can result in significant financial burden for the beneficiary.
Are Pharmacies Obligated to Provide me FreeStyle Libre on Medicare?
Pharmacies are not obligated to provide Freestyle Libre on Medicare. However, if you have a valid prescription for the device from a doctor, the pharmacy is required to fill the prescription and bill Medicare for the cost of the device, as long as the device is deemed medically necessary for your treatment.
The issue with pharmacies and Medicare coverage for Freestyle Libre lies in whether or not the pharmacy is considered a DME vendor. Durable Medical Equipment (DME) suppliers are vendors who provide medical equipment covered by Medicare Part B, including the Freestyle Libre, to patients who require it for their medical treatment.
If the pharmacy you are working with is not a DME vendor, they may not be aware of the process for billing Medicare for the Freestyle Libre. It's important to ask the pharmacy if they are a DME vendor and if they are aware of the billing process for Medicare coverage of the device.
If the pharmacy is not a DME vendor, they should be able to refer you to a vendor who is enrolled in Medicare and able to provide the device. Your prescribing doctor can also help guide you in finding an appropriate DME vendor to ensure you receive the coverage and benefits you are entitled to.
What if I can’t get FreeStyle Libre on Medicare?
If you're unable to get Freestyle Libre on Medicare, there are a few options to consider. Here are some options that may be available to you:
Contact Medicare: If you have been denied coverage for the Freestyle Libre or any other DME, you have the right to appeal the decision. Contact Medicare to find out the appeals process and how to file a request for reconsideration.
Contact your doctor: Your doctor may be able to help you navigate the appeals process or recommend alternative DME suppliers that are enrolled in Medicare and can provide the device.
Look for financial assistance programs: There are organizations that offer financial assistance for people with diabetes who cannot afford their medical equipment. For example, the American Diabetes Association may have information about programs that can help.
Consider alternative devices: If Freestyle Libre is not covered by Medicare or not available to you, there are other continuous glucose monitoring systems (CGMs) and traditional blood glucose meters available. Talk to your doctor about which device may be right for you.
Contact advocacy organizations: There are diabetes advocacy organizations that can help you navigate the process of getting coverage for the Freestyle Libre or other DME. These organizations may also be able to provide support and resources to help manage your diabetes.
It's important to remember that managing diabetes can be expensive, but there are resources available to help. Don't hesitate to reach out to your doctor, Medicare, or advocacy organizations for assistance in getting the medical equipment you need to manage your diabetes effectively.
Final Thoughts
In conclusion, continuous glucose monitoring systems like the Freestyle Libre have revolutionized diabetes management, providing real-time data and insights that help people make informed decisions about their health. However, for Medicare beneficiaries, getting coverage for the Freestyle Libre can be a complicated process due to issues with DME suppliers and pharmacies. It's important to ensure that the prescribing doctor deems the device medically necessary for home use and sends the prescription to a DME supplier enrolled in Medicare. If the pharmacy is not a DME vendor, they should be able to refer you to an appropriate vendor who can provide the device. If coverage for the Freestyle Libre is not possible, there are other options available such as appealing the decision, seeking financial assistance, or considering alternative devices. It's important to remember that there are resources available to help manage diabetes effectively, and reaching out for assistance is essential to ensure you get the medical equipment you need.