Oregon Health Authority Moves to Limit Coverage for Self-Monitoring Diabetics

For years most of the diabetes care community shared a simple mantra: when it comes to blood sugar levels, diabetics should test, test, test.   It’s not so simple anymore. Now the Health Evidence Review Commission, the body charged with reviewing costs for the Medicaid-funded Oregon Health Plan, wants to reduce the number of diabetes testing strips given to some diabetics from several per day to one per week.    At the commission’s Oct. 10 meeting, it cited a review of diabetes testing strip practices that found that, for many self-monitoring diabetics, testing more than once a week has absolutely no medical benefit. But many in the diabetes care community disagree with that finding, and are up in arms about limiting the number of testing strips.      “Having patients monitoring once weekly is useless,” said American Diabetes Association Chapter President Dr Andrew Ahmann in a press release. “There is no way that once weekly monitoring would do anything to reduce high blood sugar.”   The proposed cutback would only affect those on the Oregon Health Plan who are still on fee for service and not enrolled in a coordinated care organization. In that group there are roughly 8,000 people with Type II diabetes who do not require daily insulin and have a history of managing their condition. Type I diabetics, patients who need insulin, newly diagnosed patients, and those who have a history of changing symptoms would not be impacted. Statewide, 82,000 people remain on a fee-for-service plan.     The CCOs will not be forced to follow the commission’s lead, but could voluntarily do so, which concerns advocates.     The state has not shared any estimates on the price cost saving of reducing the test strips, according to Dr, Jeanene Smith, chief medical officer of the Oregon Health Authority.  But each testing strip costs Medicaid .65 cents, while a box of 100 ranges from $6-10 at local pharmacies.    In an interview with The Lund Report, Smith emphasized that any changes would be driven by medical considerations, and cited a recent study by the Washington State Health Care Authority that found that too much testing could lead some patients to skip meals or add extra insulin, resulting in low blood sugar.   “The evidence shows that, if you are a diabetic who is in control of your condition, testing too frequently could lead to low blood sugar,” Smith said. “Over testing also has its hazards.”   But Judy Fry, a self-employed nurse and diabetes educator, says that Smith’s claim “makes no sense whatsoever.”    “If frequent testing was problematic it would not be recommended by most of the diabetes community,” Fry said. “Testing just gives you a number. Testing does not make you have a low.”   Fry and others who treat diabetics are concerned that a decision by the commission to limit testing strips could inspire a similar reduction by private commercial insurers.    “They always follow close behind,” she said.    The commission expects to make a decision when it meets Dec. 5.    Miles can be reached at [email protected].     Image for this story by Sriram Bala (CC BY-NC 2.0) via Flickr.