My insurance plan has out of pocket expense where a specialized drug costs $50 for 30 days supply and if its prescribed for 90 days it will become 3x so, $150. When I applied from Dexcom website I could see that my Dexcom G6 transmitter was prescribed for 30 days so it showed $50 as out of pocket for in claims details. Now, I have been prescribed it though Walgreens where they filed the 1 transmitter for 90 days which made my out of pocket to $150. Can the physician change the 1 transmitter supply to 30 days instead of 90 days? This would save me a lot. Please someone let me know if this is possible.
No, 1 transmitter is intended to last 90 days so a prescription won’t be written to get one new one every 30 days unfortunately. We are in the same boat…prescriptions every 90 days. We would love to have one in reserves but the way the system is designed, the transmitters are hard to get a surplus/stock of unless you want to pay for them in cash out of pocket…which I won’t do.
Also, if you’re getting the Firefly G6 Transmitters shipped to you (The transmitter ID for G6 firefly starts with 8Gxxxx and the transmitter is visually different than the old ones.), you can’t do a transmitter reset on those either as you could previous versions as well as was possible with the G5 transmitters
You might want to look at what the cost would be to get the Dexcom filled as Durable Medical Equipment (DME) rather than a prescription. That might be cheaper.
Though all of that could be out the window when the G7 is released…
Somehow, my prescription for g6 transmitter is written as a 30 day supply, so I’m paying $30 for it as opposed to my usual 90 day supply at $75. I’m allowed one every 68 days.
But Express Scripts, which manages my prescription benefits, rarely knows what the retail stores are doing. (One of the reasons that I switched from mail order to Walgreens and CVS.)
@devineni: welcome to FUD! You could try for the durable medical device approach, but normally a co-pay on a US insurance policy for DME is a percentage of the cost; the “cost” of the transmitter is $300 +/- ($295.21 in my case). So if your DME copay is below 50% you will probably be ahead. I should add that previously people here (including me) have reported that the DME suppliers add a further markup to the cost which can make it more than the marked up price for a pharmacy benefit (i.e. something you get from Walsomeone).
My personal experience is that this is a whole load of wasted effort. Add the cost of the sensors; they are $400/shot, but in this case that is a 30 day supply. So, as they say, what you win on the swings you loose on the roundabouts; 90 days of sensors runs at $1249.22 for me, but it’s $150 for you; well under a 20% DME copay.
At the end of the day when you start using a CGM you stop worrying about copays because since the introduction of the ACA you will almost certainly meet your “out of pocket maximum”. Over the last few years I haven’t paid anything to anyone after the solstice.
Look at your out of pocket maximum. Do some arithmetic. Most people who have a choice and do that end up going for the absolute cheapest medical insurance they can find that conforms to the ACA. The world for me is a simple addition - cost of premium plus cost of oopmax. Medical expenses for the year, covered. All of them - I haven’t paid anything since January, thanks to the very great expense of fixing a thrice broken collarbone.
You do have a choice. If you are on an employer plan that sucks you can sign up for the ACA, because anyone who gets paid enough can. Just do the math. You can report your employer for being a Richard too.