June Voros sprang from her couch as a high-pitched beep warned her that she needed a quick dose of sugar. Her blood sugar was plummeting, and the beep came from a continuous glucose monitor attached to her abdomen. The small but powerful device alerts Voros when her blood sugar is dangerously high or low.
“My blood sugar is at 64. It’s too low and still dropping,” Voros, 32, said on a bright October afternoon. She checks the monitor up to 80 times a day to help prevent complications from Type 1 diabetes.
But the monitor means little without the supplies that make it work, including a receiver, a sensor, and a transmitter—some of which must be replaced every 10 to 30 days. Voros also has an insulin pump, which delivers a steady supply of that hormone to her body, and it requires supplies too.
Until recently, Voros—who is covered by Medi-Cal, California’s Medicaid program for people with low incomes or disabilities—spent countless hours on the phone with her endocrinologists, her Medi-Cal insurer Health Net, and a medical supply company to obtain separate approvals for each item. At times, her authorizations expired too quickly, leaving her short on supplies and forcing her to ration and seek donations on social media from other diabetes patients.
Last year, she received only enough supplies to last six months.
“I’ve had to put in hundreds of hours over the phone in the past few years, and I’ve changed my insurance group twice because of this,” Voros said before slugging apple juice in her studio apartment in the Mission Hills neighborhood, a suburban neighborhood in the San Fernando Valley.
Starting in October, Medi-Cal began relaxing prior authorization requirements that have caused life-threatening delays for Voros and others with diabetes.
Previously, authorizations for medications and supplies lasted six months, though for some patients, like Voros, they expired sooner. Under the new rules, authorizations are supposed to last one year from the date of approval and can include all needed supplies—ending the scramble to secure separate authorizations for each piece of equipment. Patients can receive 90 days’ worth of supplies and medications at once.
The state is also formalizing a policy that allows patients to obtain approvals from their health care providers by phone or video.
“Before, California’s requirements were four pages long, and now it’s just a little more than a page,” said Lisa Murdock, chief advocacy officer for the American Diabetes Association, who helped push for the changes. “This is a really important step forward. It means not having to constantly guess how blood sugars are doing.”
Over the past two years, the state also started making continuous glucose monitors and related supplies available to many more people, including all patients with type 1 diabetes, a chronic autoimmune disease that attacks insulin-producing cells in the pancreas, and those with type 2 diabetes, gestational diabetes, and hypoglycemia, or chronic low blood sugar. Before last year, the monitors were available to only some patients on a case-by-case basis, according to the state Department of Health Care Services, which administers Medi-Cal.
The enhanced coverage extends to newer, more advanced devices, such as the popular Dexcom G7 and its components, which retail for about $700 on Amazon for a 30-day supply without insurance. Medi-Cal pays roughly $400 for the same equipment.
Diabetes and prediabetes are on the rise in California. About 3.2 million Californians have been diagnosed with diabetes. The Department of Health Care Services says about 1.2 million Medi-Cal enrollees have the disease, according to the latest data available.
Before these changes, Medi-Cal recipients had a harder time securing medication and supplies than people with private insurance, Murdock said.
“Diabetes is a really heartbreaking and costly disease, and to take care of themselves, people with diabetes need easy access to insulin, but also the supplies to manage the disease,” she said.
Patient advocates and state health officials say the changes will save money and lives by giving those with diabetes more control over their blood sugar, and by preventing complications such as organ failure and foot and toe amputations.
This expansion in coverage “improves access and member outcomes, reduces hospitalizations and comorbidities, and improves members’ quality of life with better disease management and less finger sticks,” said Ann Carroll, a Medi-Cal spokesperson. The state, she said, wants to ensure all diabetes patients get “the care they need to lead healthy, fulfilling lives.”
Before Voros got her monitor about three years ago, she had to visit an emergency room repeatedly for seizures and was hospitalized with other diabetic complications. She also lost nerve function in her stomach—which prevents digestion of high-fiber foods like vegetables—as her disease advanced.
“I haven’t had to go to the intensive care unit in almost two years. It has literally saved my life,” she said.
But the bureaucratic hurdles that kept Voros from getting supplies for her monitor were a constant source of stress. That’s changing since she switched to a new medical supply company and Medi-Cal has debuted its new preauthorization process, amid a broader revamp of its pharmacy system.
2023 KFF Health News. Distributed by Tribune Content Agency, LLC.
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