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

The Health Evidence Review Commission will decide whether to reduce the monthly glucose testing strip allowance for some diabetics at its Dec. 5 meeting
November 4, 2013
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.


Submitted by Jeff Heatherington on Thu, 11/07/2013 - 14:05 Permalink

This is a terrible recommendation, and one that most CCO's will not follow. Glucose monitoring is an essential health habit for anyone with diabetes. FamilyCare will continue to offer coverage regardless of whatever decision is made. The unfortunate fact, however, is that if monitoring strips are deemed to be not covered, those CCO's that continue to do so will be penalized. The cost of "non-covered" services that are provided to Medicaid clients is deducted (not ignored, deducted) from the overall medical cost of the CCO in determining future premiums.
Submitted by Janet Kennedy Unitan on Mon, 11/11/2013 - 11:34 Permalink

I agree with Judy Fry and am shocked to read that the chief officer of Oregon Health Authority is in-line with over and under testing "hazards" ? Perhaps this is more of business cost decision rather than a health issue as is currently targeted. It appears she is not familiar with Type One and Type Two Diabetic needs.
Submitted by Liliana Wells on Thu, 12/05/2013 - 05:56 Permalink

I wonder where Dr. Smith got her degree or if she even knows what diabetes is. She is paid by the Oregon State Health Systems, right? Of course, she has to say Type 2 diabetics don't need to test often. She. was probably told to find ways to save money or else her job is on the line. What she/they don't realize is that if you test only once a week, the damage has already been done if your glucose level is high. This means that as time goes by complications set in and the State has to pay for doctor's visit, more costly tests, possibly hospitalizations, surgeries, therapies and so on. What's there not to understand.