FUDiabetes

Dexcom G6 via Pharmacy/Drug Benefits

We have been getting Dexcom supplies from Distributors and direct from Dexcom (sometimes one sometimes the other) for about seven years now. These supplies are run through the DME portion of our Health Insurance.

For reasons better detailed in other threads (please don’t hijack this thread) our attempts to obtain a new sensor order were going extremely poorly with no indication of any movement.

I thought this would be a good opportunity to try getting the Dexcom G6 supplies from our local Pharmacy (national chain) via our Pharmacy/Drug/PBM benefits.

Tuesday:

  • I walked in to Pharmacy with G6 NDC codes for transmitter and sensor and asked if they could order them. Pharmacist Tech looked them up and said yes. I provided the page from Dexcom with the NDC codes.

  • I checked current version of our PBM Drug List dated effective as of this year. Verified Dexcom G6 is listed per PBM.

  • I logged in to the online portal for our Endocrinologist and sent a message asking for our Endo to send a new script for the G6 sensor and G6 transmitter to our local Pharmacy. I provided the example of how Dexcom shows to write the script. I told the Doc we only wanted transmitter and sensor but did not want nor need a receiver.

Wednesday:

  • Doc electronically sent a new prescription to the pharmacy and FYI’d me back that the script had been sent.

  • Pharmacy sent me a txt msg indicating they were out of stock for the Dexcom supplies.

Thursday:

  • Pharmacy sent me a txt msg letting me know the supplies were in and ready for pickup.

  • I picked up one G6 Transmitter and one box of G6 sensors (three sensors in the box). Good dates on all supplies.

  • No issues of any kind including no insurance issues.

This was easy. And extremely low stress.

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How to Fill Dexcom G6 CGM Pharmacy Prescription
(NDC codes - for the Pharmacist)
https://provider.dexcom.com/education-research/clinic-resources/prescribing-info/how-fill-dexcom-g6-cgm-pharmacy-prescription

= = = =

Dexcom G6: How to Write a Pharmacy Prescription
(for the doctor)
https://provider.dexcom.com/education-research/clinic-resources/prescribing-info/dexcom-g6-how-write-pharmacy-prescription

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Thanks for posting this information, I honestly have never looked at if it would be cheaper or easier to use our Pharmacy or DME benefit to obtain the sensors. Interesting thought. Is one cheaper generally, or is it a case by case look at your policy thing?

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I noticed dexcom G6 is now also on goodrx, so you may be able to get further reduction from your plans pharmacy pricing.

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Anyone using the Caremark/CVS pharmacy plan for Dexcom?

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@jim26
You would need to check with your specific insurance plan.

Per original post - checking your plan formulary is how you find out.

“I checked current version of our PBM Drug List dated effective as of this year. Verified Dexcom G6 is listed per PBM.”

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I have CVS Caremark for mine, which allows me to fill scrips at Walgreens. I’m fortunate to live in Boston, and I have my Dexcom scrips filled at the Walgreens in the Joslin Center. Not only are several of the pharmacists T1s themselves, but they’re kinda high-profile, what with people sent straight down there from their endo appointments, and so far I’ve had no problem with sensors and even transmitters being in stock. When I was using a DME supplier, not so much.

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@Thomas, Did you ask your insurance company about it before trying this?

My plan has the Dexcom listed on the formulary. When I called my member benefits department and asked them how I should order my supplies (2 years ago), they told me that even though it was listed on the fromulary, it had to be ordered through DME.

I’m wondering now if they just didn’t know what they were talking about. It would be much, much cheaper for me to get my Dexcom supplies through my pharmacy benefit.

Edit: Looks like they changed the formulary this year, so it’s not an option anymore anyway. Nevermind.

Thanks for posting all this good info though!

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No.

Too aggravating for me.

Another one of my concerns.

I am more concerned over availability then cost. For me, cost is only relevant if I can get the product.

One of the key points of the Pharmacy (my experience) is the ease involved. If it doesn’t work - very little effort expended. If it does work - still very little effort expended.

When you go to pick up ANY order from the Pharmacy, they will always tell you how what your cost is right then right there. In my experience, the Pharmacy NEVER sends you a bill afterwards. For better or worse, you pay the entire amount of what your cost is right then and there or you don’t get the product but no surprise billing afterwards. As well, if the cost comes up either higher than you expect or simply higher than you want to pay or may just higher than the amount in your pocket at that point in time - no big deal. You are not obligated to take it. You can tell the Pharmacy you will be back later or you can tell the Pharmacy it is too much and you don’t want it and will not be back so they can simply restock it. The Pharmacy gets that sort of thing all the time so it is nothing they are not used to.

For some things, I think the easiest way to see how it works is to try it. Sometimes it works out and sometimes it does not.

If your normal supply approach is working out great for you then no need to rock the boat. Keep doing whatever you are doing. If your normal supply approach is no longer functional then it may be worth trying a different tactic.

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Perhaps an insurance company may have patient-support guidelines that send the patient to whichever option provides the highest profit for the insurance company, instead of the lowest out-of-pocket cost for the patient. Or maybe I’m just a cynical cuss.

I would go with cynical cuss. To assume that someone at an insurance company understands the data enough to tease out which one makes them more money, more likely, one area is in charge of formulary and another DME, and every couple of years someone gets a bright idea and scans to look for duplication and then removes one. The level of competence you are assuming is a high bar indeed.

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I went to Costco for the first time this week for a G6 transmitter. I had researched that they were only $27 cash pay. I pretty much thought something would happen and there was fine print somewhere. Anyway. My dr sent over the script and I went to the register and she said that’s $280 something for 1 transmitter. I mentioned the Dexcom contract. Filled out their form and she re-rang it for $27. Refillable I every three months. I was happy.

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great news and a great result!

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Generally speaking, CgMs are covered by <33% of all private pharma plans. So YMMV.

Correct, Costco has the best price anywhere in the USA. Lower than copay of most private insurance.

This is rapidly changing. Unless you have looked at your PBM benefits for THIS year then it is extremely possible the information is out of date.

Costco is not cheaper than my insurance via Pharmacy for Dexcom G6 supplies. There really is only one way to find out. And honestly - it is about as easy as it gets.

On the other hand, if one is really happy with their current arrangement for cgm supplies than that is great also.

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My cgm and pump supplies are covered 100% on Medicare and a supplemental through DME so I can’t get better than that! I wanted the extra transmitter because sometimes there is a delay in shipping or it dies early and they won’t refill until an exact date. It makes me feel safer to have one on hand in case of emergency. Costco is a great option for me at $26!

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Follow-up.

The pharmacy just refilled the Dexcom G6 Sensor script. It was on auto-fill so I did not have to call it in. Yesterday I received a txt msg from the Pharmacy that they were out of stock (shocker) and they were ordering it in. Today I received a txt msg that the order was ready for pickup. (Which I then picked up with zero issues.)

This G6 Sensor box (w/ 3 sensors) has a Pharma date filled on the 26th of the month (ie - today) with Dexcom Sensor expiration of Jan 21, 2020.

The previous (last month) G6 Sensor box (w/ 3 sensors) had a Pharma date filled on the 27th of the month with Dexcom Sensor expiration of Jan 6, 2020.

This could not be any easier.

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Except finding an insurance plan that covers dexcom as pharmacy, as fixed co-pay rather han co-insurance.
I had that for a short time, and enjoyed it while the plan covered it. Glad its working well for you !!!

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Wondering if anyone has seen this?
I found it under dexcom faqs.

Seems to be a discounted price for G6, for pharmacy purchase, for those that have G6 pharmacy coverage. Signup by 12/2019.

www.dexcom.com/pharmacyoffer

More details: