“On Jan. 1, 2027, Dexcom is off-formulary on my Aetna health plan, and Abbott Freestyle Libre is on. I’m OK with it, except about a brand new CGM Prior Authorization ¶ mandate Caremark is implementing. Non-medical switches on medical devices and medicines are all about rebate kickbacks to the insurance company-owned PBM, not cost containment. Catch my blog post at Scott's Web Log: Dexcom Is Out. Libre Is In. I'm Happy, Except About the Prior Authorization (PA).”
A new prior authorization for a CGM, from the parent company bragging that it’s cutting them.
Come January, people on at least one plan from Aetna, a CVS Health Company will need a prior authorization for their CGM that they never needed before, from a company that says it’s cutting them. Scott Strumello, a longtime advocate in the diabetes community, shared this news on his blog…His plan is dropping Dexcom and making FreeStyle Libre the preferred CGM, with the same quantity limits and a brand-new prior authorization on top.
In June 2025, health insurers publicly pledged to fix prior authorization. CVS Health, which owns both Aetna and CVS Caremark, keeps saying it is reducing them. Then it adds one to a device people with diabetes depend on every hour of every day. And the formulary isn’t any more open: one brand is in, the other is out. WHY?
Now look at what that means for the patient.
Get your endo’s office to file the PA before January 1, or risk a gap in sensors.
Learn a new sensor and a new app.
If your insulin pump talks to your Dexcom, figure out what happens to your automated insulin delivery.
Call the pharmacy, call the plan, call again.
People with diabetes already carry more paperwork than ever, and for the young adults we serve at The Link, often on their first employer plan, it’s one more thing to learn the hard way.
If your plan is changing CGM coverage for 2027, check now whether a prior authorization is required and give your endo’s office an early heads-up. Then tell me in the comments what your plan sent you.
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