Just found out we need to now go through the pharmacy for our G6 sensors and transmitters with a prescription from the Endo going forward with the change in insurance we experienced this year. I wanted to see how much of a pain this process is going to be for us going forward or if it’s easier than going through Edgepark.
Initially it was difficult because the pharmas weren’t accustomed to stocking and supplying either Dexcom or, in my case, Insulet. At the point where it became an option I immediately switched from the corporation you name but I ended up getting the Dexcom stuff from Walmart and the Omnipods from Walgreens in Portland (273 miles away); no other options at the time where I live.
My experience with Walmart has been satisfactory. I’m concerned that they manage to supply me with transmitters which have been sitting somewhere for many months but they seem to be getting better.
My experience with the Portland Walgreens has been excellent. They once managed to ship Eros, not Dash, pods but that was fixed PDQ. They are incredibly good. My local Walgreens sucks; I recently transferred all the prescriptions to Walmart.
Overall it is so much less stressful; we spent hours on the phone to the organization in question, which I won’t name. Indeed at one point my wife actually became as stressed as me, a unique experience which identifies the entity in question as something from the Lovecraft pantheon.
I’m sure you will enjoy life significantly more with a pharma.
I recently had to do the opposite. I was getting all my Dexcom supplies from Costco pharmacy and it was wonderful. Call them and it’s ready the next day at the latest. Super helpful.
Then I had to go to Medicare in Oct and now it switches back to durable medical supplies. A HUGE pain getting that set up. Insurance pre-authorization, verification of insurance (for Pete’s sake, it’s Medicare and BC/BS), already had a receiver and Medicare won’t “dispense” without a receiver so I had to track down a receipt from 2 years ago proving I had a receiver (yay for Costco!), etc etc. And literally 3 months later, I’m finally set up with Advanced Diabetes Supply. Fortunately I had a backlog of Dexcom supplies.
In my experience, you’ll love getting it through the pharmacy. And just a little tip for those who use Costco, a pharmacy tech told me that if you are a Costco member, ask for the discount. In the time I was waiting for approval, I needed a new transmitter and had to pay it out of pocket. With the discount I paid $128 for the transmitter. I don’t think it is advertised.
I don’t know as I only did it once, but it seemed a little sketchy to me, as I was never told how much the discount was, just that it would cost me $128 instead of the cash price of $277.62. And this was without insurance.
This makes more sense, without insurance.
I thought you were using insurance and got even lower OOP cost by being a member.
I think then its a choice of paying higher early with insurance, that accumulates oop. Eventually by year end they are no cost/lower cost to me, due to deductible and max oop. Due to some non-diabetes costs, I usually max out around sept.
I did have insurance, it’s just my primary suddenly changed to Medicare which only covers Dexcom as DME, while my previous primary (now secondary) allowed Dexcom as pharmacy. I never mentioned insurance to the pharmacy tech, but I assume she could see it on the computer.
I’ve read of so many having issues getting their Dexcom supply established and I sympathize as some of the hoops we have to jump thru were obviously designed by lawyers and MBAs as full employment scheme! I’ve been very fortunate (at least so far!). My Endo (not the best first experience otherwise, way too treatment conservative for me) wrote a script, called a Dexcom rep who called me to confirm insurance, passed the info to a Dexcom supplier (Well Start) who called me, asked which pharmacy I used (DOD off installation pharmacy), and I got my first supply all within a week. I have Medicare primary with Tricare For Life (DOD Tricare for retiree’s of Medicare age) secondary. I should check the EOBs and see who’s actually paying or if it’s shared between them. I know both cover CGMs; I think Medicare covers as DME (ergo the PDM requirement) under Part B and TFL covers as DME as well. All drugs are definitely covered by TFL with no copay if picked up at DOD pharmacy, copays of varying levels if via DOD/Express scripts mail order or network pharmacy, and higher copay for non-network pharmacy.
I will never understand why we’ve established an absolute maze of a system for our oldest generation, it’s ripe for fraud and gouging by the entire medical/insurance community for what is probably our most vulnerable population! Would that AARP actually spoke for and achieved goals for us vice colluding with United Healthcare all the time!
This is one of the things I find infuriating about the current gov/political system. We have known for years that medicare is broken and they just keep putting band aids on to fix problems which makes it even more complex and expensive.
Something both political parties should be able to get behind is a Medicare simplification act. Government shouldn’t be in the business of running and managing major services as they have proven time and again how inefficient and mismanaged they are.
Just the stories of all the hoops people have to jump through just to get test strips is insane. A test strip prescription should be a slam dunk. If they can’t improve that process I can only imagine a situation that really is complex and trying to work through that red tape.
Or the fact that Medicare “approves/disapproves” the drug you can take. In RA (rheumatoid arthritis) they won’t cover a biologic DMARD (newer treatment given by infusion and expensive) until you’ve tried and “failed” with at least one of the traditional DMARD drugs. Despite the current RA philosophy that starting with more aggressive treatment for newly diagnosed results in better outcomes.
My understanding is that it is the standard CostCo price for members without insurance, but if you have insurance you have to use that, for some definition of the latter use of “have”. It’s been discussed before, here I think but if not on TUD.
Or have insurance, but the item is not covered, or higher cost.
However, depending on your full year costs, choosing a higher cost may help reach max oop, so after that all covered expenses are 0.
When I got my pump in 2020, I knew I would max out. So choosing between lower cash pay and insurance covered, I chose insurance to get to max sooner and be irrelevant what was charged. End of year most was 0. And did some procedures I had been putting off, fully covered.
Indeed, that’s why I don’t care either; my OOPMax is $6700 this year, I will reach that PDQ so it doesn’t matter how I reach it. It would be easier for me to just pay it up front and then not have to get the Walmart pay system to actually work, or worry about exactly how much I have to shift into my bank account exactly when to cover the temporarily high credit care auto-pay.
Yes, and I checked out all the expensive procedure stuff too in 2021.
It’s very certainly a very stupid system. Of course it does mean some people with insurance can’t actually use it and have to pay up front for everything, even though they have insurance, but that’s a different thread on FUD. They pay the inflated price twice for the same thing.
OK, I checked my EOBs for Medicare and Tricare, and now I’m concerned. For my last Well Start bill for Dexcom G6, the bill was $550; Medicare paid a whopping $1.28 (that’s not a typo), and TFL paid ≈$238. I haven’t received a bill from Well Start, so I’m assuming (hoping?) there isn’t a vast “unpaid” amount hanging out there that will eventually catch up to me! In actuality, I’m assuming the amount paid has been negotiated down by some PBM dude wearing a green eye-shade. Now we KNOW Well Start and Dexcom are making a significant profit on the amount paid, as well as the PBM presuming there is one, so the egregious profit on these things has to be absolutely astounding…alternately, we US residents are helping pay for those shipped to the rest of the world! It’s mind boggling!
Been getting the run around on these supplies since switching companies/insurance providers. Still BCBS PPO but apparently different plan than I had in my other company. CVS came back saying insurance the Dexcom supplies aren’t covered being filled at the pharmacy. The Endo is now telling me they’re “likely covered DME” still but through another supplier…“Byram”…never heard of them. So now we’re reaching out to them to see what’s up. He was due his Dexcom sensors/transmitters a couple weeks ago now. Hopefully we’re able to get resolution on this matter soon…we have a call into Bryam today to see if they will have us or not. lol.
I hate not having a Transmitter in reserve…may actually end up just buying one out of pocket just to have that security. It’s a shame that you’re never allowed to have an extra in reserve through insurance.
His current sensor is crazy eratic too this week…twice he’s been low according to the CGM, but his actual sugars were well over 100…we’re talking long spans of time too…over an hour each time. And when you calibrate, you get put into the calibration loop…so you have to decide…do I want the loop which is going to take an hour or more to clear up, or do I want the CGM to just keep reporting low for however long it decides it wants to report it. I’m talking massive differences…CGM reporting “LOW” (39 or less) but repeated fingersticks saying 150 - 190 every time. These are the times I get frustrated now adays with diabetes management…1) the hassle insurance puts you through to get your supplies and 2) when the tech fails.