FUDiabetes

Freestyle Libre sensors may need to be durable medical supply for insurance

Well, the process has been started for the dexcom, after talking to the company I am rather excited because it seems like it will do so much more than the Freestyle Libre. Don’t know if anyone else can benefit from this information but I have been getting my sensors for the libre through W******t pharmacy. I pay out-of-pocket $75 a month I thought it was kind of steep but well worth it. After calling my insurance company to see what I would be paying for the dexcom they told me that W******t has never submitted a claim the reason I was paying $75 Is because the claim should have been going through my insurance as a durable medical supply and not the pharmacy, at that point I would have only had to pay 10%. I know insurances everywhere are different I live in Pennsylvania perhaps this info can help someone else if they were as naïve as me and trusted the pharmacy to handle it all.

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Gosh, so sorry to read this. This is worth its own thread.

Btw, this may vary per insurance company. But still a major goof from the pharmacy :frowning:

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I dont think walmart can file dme claim. But is confusing because some plans cover as RX, which can be processed by walmart.

My plan does not cover libre either way, so i have paid OOP, using discount card from libre.

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When I contacted libre asking if they offered a discount card for those paying out of pocket I was told they did not offer one.

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Here is one discount, but not one that i used.
https://www.goodrx.com/freestyle-libre

Since i use dexcom, i was able to get discount coupon from Libre website. Had to enter my dexcom number. But it was good for free reader and i think one sensor.
If i stop dexcom, i would switch and use the goodrx discount, which may be lower than what walmart was charging you.

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This really must vary from policy to policy because Libre is considered a pharmacy benefit with my insurance which is why I can use it alongside either the Guardian or G6.

This doesn’t mean I don’t think my pharmacy or my insurance company are robbing me. I know they are. :smiley:

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While you are throwing shade, don’t forget, Pharma companies, PBM’s and hospitals who are all also contributing to the problem of affordability.

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I don’t have enough time in this next week or enough savings in my mental wellness bank to share even the tip of my feelings with this and be able to recover my good mood before tomorrow.

Criminal, shameless, detrimental, cruel… I can say that much before hurrying back to happy thoughts.

…Nope. Damage is done. Damn.

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I am sorry for negatively contributing to your mood. I will lash myself severely tonight.

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Bounced back. You can scratch that from your plans. Unless you’ve already… :grimacing:

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DEXCOM IS ON ITS WAY TO ME…doing my happy dance!

Had to do finger sticks for the last week while insurance was processing, made me realize what a blessing the CGM is.

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Happy for you.

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There is finally something nice about turning 65 years old in the U.S. Medicare considers CGM a “durable medical device” 100% covered under Part B. Except for having to deal with idiots at my supplemental insurance provider, BCBS of Michigan, my Freestyle Libre comes completely free. Apply through your supplement insurer and be prepared for six weeks of back and forth discussions about the hoops you and your prescribing doctor have to jump through.

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If an Insurer covers the Libre as DME and not as a prescription, then should you stop picking the Libre up at a Pharmacy?

I did not know that is was covered as DME until I contacted them to see what I would pay monthly I was paying almost 75 monthly with the understanding that I was paying a copay. Only then did I find out that I was paying the full amount and a claim was never submitted. I was lead to believe it had been submitted and I was simply paying my portion. Now that I know better I am getting my CGM from a home equipment company and it is processed as DME. I trusted my pharmacy was handling things properly…now I know I need to do better research.

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Frustrating. I guess if the credit card accepts the transaction, then they did their job! /s

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I have cigna insurance and use Carecentrix as their durable medical carrier… in Jan they told me they needed a 90 day prescription for the libre, and after they receive the prescription, they will tell me how much it will cost… $1632 for the first 90 days, and the 2nd should reach my $2500 deductible, which is then covered by 80%…refused and picked a few up at the pharmacy for about $66 for 2 14 day sensors, but went to eversense with their $99 bridge program and even got eversense to work with my watch and xdrip

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I use libre 14 day and its a prescription benifit, i get from pharmacy. When i was first looking into the braum to me they would be like 399$ a month for sensors. Rep told me to get script and go to local pharmacy which I did. Big difference in cost.
If you do don’t get discorged, to two weeks to get strait, pharmacy didn’t know correct code. Finally my insurance called them and walked them through it after about 3 tried from them and as many calls from me to insurance co. But now every24 days I walk in and they are waiting for me.

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