Hello All,
I am in sticker shock as to the price of the Dexcom G-6 through a diabetic supply house using the in-network DME side of my employer-sponsored insurance.
So I m wring an appeal to my insurance carrier to request if they would cover my Dexcom G-6 under the Pharmacy benefit.
So before I write this appeal letter to my group health insurance wanted to gather some information from the FUdiabetes Group.
Those who wish to answer my question, thank you in advance for your candid answers. My question is: If your Dexcom G-6 System is covered using your pharmacy benefit, which employer-sponsored health plan insurance company gives you this benefit?
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Unfortunately, the problem with the dexcom g6 is the transmitter which is only supposed to last 3 months and will be durable medical 100% of time. Medicare can cover it, which is great, and many users can advise you how…however, if you are like me and are too young for medicare, you will most likely end up using the libre, xdrip, and miaomiao2… I’ve been using this set up off and on since 2017, and it is much cheaper than The dexcom…Dexcom knows this, which is why the Dexcom 7 will be very similar to the libre…however, I imagine it will be more expensive. Most insurance companies have figured out how to avoid prior authorization games by offering co pays and high deductibles… my deductible is $2500, however, it pretty much only applies to DME or emergency serviced…I would imagine yours is similar… I would give up on the dexcom and look into the libre, miaomiao2, and op site flex fix tape to hold the miaomiao2 in place…you’ll end up saving yourself a lit if headaches and money
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We have a few members that have reported being able to obtain the Dex through their pharmacy benefit. I am sure they will be shortly. We are not one of them.
Roger ,
What is a Miamia 02 ? I’ve never heard of them .
I recieve my G6 Dexcom senor and transmitter through Caremark/CVS pharmacy benefit. So far I’ve had nothing but good luck. My pharmacy has the sensors available the sameday.
You need to check with your pharmacy benefit provider to verify coverage, because it depends on what plan your employer has with the provider.
Miaomiao2 is an NFC to Bluetooth transmitter that reads the libre every 5 minutes and transmits the signal via Bluetooth to your android phone… unfortunately, apple has to use another device(blucon), but either one works fine. The miaomiao2 is waterproof and rechargeable… amazing that they can figure this out and dexcom can’t… and is a one time $200 (including shipping) purchase… I would call your insurance company In The morning to find out if you can obtain the Dexcom through the pharmacy… I have Cigna, and they told me no pharmacy…
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My plan changed to use Express Scripts PBM this year, and now I can get dexcom as pharmacy at lower cost and more convenient.
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I wouldn’t spend a lot of time on the appeal…it seems like some insurance options will cover Dexcom through the pharmacy, but these are usually plans from larger corporations or larger employee numbers, government jobs, etc…the miaomiao2 is still a very viable option…many users use the same xdrip program for their Dexcom, so the software is equal
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I’ve been getting G5 sensors and transmitter at pharmacy for a while, at least a year. The simplest way to explain it is: I pay the DME co-pay (20%) but the co-pay is based on the “list price” from my pharmacy. This saved me a lot of money compared to a 20% co-pay from my insurers DME supplier (Edgepark in my case). The “list price” from the pharmacy is about one third of Edgepark’s price. It took a lot of emails and phone calls to get this set up but it was well worth it.
Switching to G6 soon…will let you know if it’s covered as pharmacy benefit.
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I’ll say it again how much I love Dexcom through the Pharmacy. Ordered sensors yesterday evening through the CVS app and available for pickup today.
No stress of dealing with Dexcom. Probably one of the best diabetes enhancements in recent memory.
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That sounds really lovely. Won’t work for us with our current insurance, but a boy can dream…and live vicariously through you.
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Did you recheck this year?
Last year my plan changed to do pharmacy coverage, when it switched to Express Scripts. But I did not realize at first, so got them dme. Now do pharmacy and it is a bit cheaper and more reliable.
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Yes, we use the big HMO on the west coast that starts with a K. They only have one way for us to get the equipment.