FUDiabetes

Reminder: Check Your Pharmacy Benefits

Summary: You’ll often pay much less getting your Omnipod Dash pods and G6 CGM sensors from the pharmacy.

Details: Just had a good news experience on some diabetic supplies, and wanted to share it with you.

Up until now, we’ve been getting my daughter’s Omnipod Dash pods directly from Insulet. We first had to pay our deductible ($4,000), and then our insurance covered 20% after that. The pods are over $250 per month. We thought we’d always meet the deductible every year, and considered that the cost of diabetes.

I just switched jobs. My insurance carrier is the same - UHC PPO. Still has a $4K deductible. Same website, etc. Appears identical. However, my new plan has better pharmacy benefits. For some reason, we pay $10 per prescription, even before meeting the deductible. So we pay $10 for insulin vials, pens, pen needles, even G6 sensors, etc (previously, we paid 100% for G6 sensors from CVS before deductible, but strangely, 0% after meeting deductible). But I was not aware we could get Omnipods from CVS. I had Insulet quotes us the price with new insurance, and it was the same — meet the deductible first, then we pay a cost-sharing amount.

After a little research, I learned you can now get pods from the pharmacy (CVS, etc). I had my daughter’s doctor send in a script for Omnipods to CVS, and CVS is filling it — for $10/month! It was so easy and simple.

Another benefit of using pharmacy: CVS instantly quotes you a price, and you pay it at the register, and you’re done. No waiting nervously for the invoice to arrive, hoping insurance paid the right amount. CVS’s system communicates instantly with my insurance company, giving me full price transparency, and instant knowledge as to whether an item is covered or not.

We now get literally all of my daughter’s diabetic supplies from CVS, and are paying $10 per prescription, no matter the item. This is unique to our insurance plan, but I was lucky to find out the DME vs. pharmacy cost difference. Had we just continued to get pods directly from the maker, basically as a DME (Durable Medical Equipment) provider, we’d be on the hook for over $3,000 per year. Always try to get supplies from the pharmacy!

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Glad you were able to figure that out. That is a huge cost savings!

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That is fantastic. My insurance recently stopped working with Insulet directly and told me that I’d have to get my Eros pods from Edgepark. I did not ask if I could get them via a pharmacy but that is a good suggestion. I will ask Cigna if that is a possibility.

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Often the best way to find out if your insurance will cover a diabetic supply as a pharmacy benefit is to have the pharmacy try to fill it and see what they charge you. When I asked UHC if they cover Dexcom sensors via pharmacy benefit, they flat out told me no. But the pharmacy processed it just fine. The insurance agents were misinformed about this.

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I tried this at Costco and they did check, but mentioned they are charged by the insurance when they do it.

Most insurance plans have an employee website for RX plan with Caremark or ExpressScripts, etc. Can check cost, coverage, review history etc.

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@justin some UHC plans do cover Dexcom as a Pharmacy benefit, the caveat being that you can ONLY get it filled by UHC owned Optum RX as a 90 Rx.

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This was not the case for me and my UHC PPO. Optum rejected them outright, currently waiting for my Endo to see where they can contract a DME billing for me. So frustrating!

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@Necroplasm I had the same experience with UHC PPO. After trolling through the pharmacy benefits page I found a file marked as Nationwide MM. My Dexcom was listed. I needed to get a PA then Optum has been filling the RX every 90ndays to day without my having to request it.

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you might just need a PA, which you would find out about if you appeal the decision.

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I signed up just to tell people.
Costco has these on hand usually and for a discount. If you dont have insurance, there is a cost reduction form that you can use as well. Not sure if this is common knowledge, and it does require a Costco membership…

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Hi @torhne, the Costco discount is part of the Costco Member Prescription Program (CMPP). The program is cash only/no insurance and has had healthy discounts on Dexcom products in the past.

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I will make sure to see what I can do about that ty

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