Going on 6 years of my pharmacy and medical coverage both having specific exclusions to get out of covering CGMs, and the OOP costs just keep going up.
I paid $179 for 3 Dexcom G6 sensors in January (stretched out use by restarting), got a trial freebie Libre 3+ in March, and have been mostly without any monitoring (save finger sticks) since. Truly don’t know what to try next, and doctor’s office and both insurance companies are no help at all. I’m not entirely sure what’s on the market/what’s going to be discontinued this year?
@Pianoplayer7008 I echo the welcome back of @Eric. Sorry your facing the issue and wish I could advise, but I’ve also only used Dexcom G6/7 and Omnipod Dash, and I don’t have the issue of OOP. Any chance of changing the insurance you have? To something covers at least part of the cost CGM? Do they cover test strips/testers? Hopefully, others here can provide better support than I can.
Back about 10 years ago I was in the same boat while I appealed the coverage with my insurer. Dexcom sold me a package at a decent discount…my recollection was if I bought 6 months of sensors the receiver and transmitters were free. (Or something like that.) No idea if they still do discounts for cash payers but it is worth asking each of the companies.
To answer your question, it seems to me that Dexcom G6 would be the most cost effective because (a) it can be restarted and maybe get more days out of each sensor, plus replacements for every sensor that does not go a full 10 days and (b) as more people switch to G7 there might be surplus G6 sensors and transmitters for sale around the internet.
In case you are appealing the coverage with your insurance, don’t give up. What finally won my appeal was review of the coverage policy by the insurer (every insurer has these in writing), submittal of an appeal letter referenced to that policy, and constant phone calls until I finally found some people at the insurer who would read the letter and respond to tell me what additional documentation they wanted to see.
Thank you, @Eric and @TomH! You’re both reinforcing my love of the Dexcom G6, which I did (unknowingly; long story) pay OOP for from Jan-Sep of last year. And TomH, my pharmacy insurance asked me the same thing, but since I’m only part-time (self) employed, we’re dependent on whatever insurance my husband’s work chooses.
@John58, this is helpful - thank you. I’m about to start working on the appeal process, and it’s at least nice to know persistence paid off for you. Sometimes I get weary of all of the back and forth.
I paid $1094.52 on March 13 2025 for a 90 day supply of G7s, so 9 sensors. That’s $364.84 for three. Assuming you are in the US and using insurance you are doing pretty good.
Forget the “free trials” (you pay with your data which is very very valuable to the manufacturers). The base price for any single item for someone with a disability is $300/month.
This is why when we look for insurance policies, or jobs, we must consider the OOP max. That is what we will pay; that’s it. Forget what one or other thing costs, it’s the OOPMax that matters.
Not just us. Everyone; disabled or not! When something bad happens we pay the Out Of Pocket Maximum and, before the ACA, for most people that meant we went bankrupt. IRC my OOPMax before the ACA with Oregon’s backstop BCBS covered plan was $30,000. The same for my wife. Crash my car pay $60,000 and no car.
If I wanted Dexcom CGMs without insurance I’d buy a ticket (not first class; last time I thought about that it was $10,000) and buy them somewhere else then illegally smuggle them into the US (where they are a prescription item, so can’t be imported without a license). Well, no, I wouldn’t do that; I don’t break the law. I just wouldn’t come back.
GoodRX shows a price of $189 for 3 G7 sensors (so $64 each). (GoodRX is an amazing way to get much better prices on prescriptions from your local pharmacy. I used it all the time when I was on a high-deductible insurance plan.)
I currently have an $11 copay for each sensor through my health insurance.
If I was facing this question, I think I would pay the higher price vs not using a CGM.
