FUDiabetes

You might want to revisit your insurance coverage of Dexcom supplies- things could have changed for the better

My 14-year old son was just diagnosed with T1D. Hospital trip for DKA, bad times. But that’s just background for something that might help others here out.

In the process of getting him his own G6 I discovered that my insurance (Blue Cross Blue Shield Federal Employee plan) now covers G6 supplies as a pharmacy benefit instead of as a medical device like they used to. I have been ordering my supplies from Byram Healthcare as a medical device, which requires me to pay a $350 deductible every year. Now that I can order through my mail order pharmacy (Caremark) it is not subject to a deductible. This could save me up to $260/year in Dexcom supplies per person. If you’ve been ordering your supplies the same way for a while you might want to check to see if your benefits have similarly changed in ways that could end up saving you a lot on supplies.

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Thanks for sharing. That is fantastic that you can save that much and still get the G6. Sorry about your son. My son was 12 when diagnosed. Never fun, did you catch it before DKA?

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Nope. We thought he had a stomach bug. He had been feeling bad, then puked one night. When he wasn’t any better the next morning and started having other symptoms we took him to urgent care, where he started having trouble standing, walking, and speaking. After an ambulance to the hospital and a night in the PICU his blood glucose and bicarbonate was good enough to release the next day. I really liked that the diabetes educators didn’t waste time telling us things we already knew because I’ve been T1 for so long. I also like that when I asked his endo when we could get him on a Dexcom her immediate answer was “Yesterday”.

He’s fine now, but still a bit high. I can’t wait to get the G6 and figure out what’s really going on and stop waking everyone up in the middle of the night to do fingersticks.
One thing does have me a bit worried- he’s been complaining about his fingers tingling “like I’ve been using the leaf blower”. Could neuropathy set in that fast? Could it be temporary?

Other good things happened to my insurance this year- I had noticed that my copay went from $80 to $40 for a three month Rx, but what I hadn’t noticed was that they’re now charging the same copay for all insulin. Tresiba is the same as Lantus and Basaglar. This is really odd because when Basaglar came out they bribed the hell out of me to switch to it from Lantus to cut their. Now they don’t care about costs? Huh? Did all of that bad press for skyrocketing insulin costs actually accomplish something?

I also learned that they don’t even need any prior authorization to get a Dexcom anymore. If you have a 90-day Rx for insulin it’s automatically approved and covered. Wow. I really had to fight & drown them in paperwork to get my first SevenGo.

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Love using the Pharmacy benefit, besides the money so much easier dealing with Caremark/CVS than Dexcom and DME.

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Agree!!! My insurance also switched to Pharmacy benefit, and I am using Costco to fill dexcom sensors and transmitter.

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Express Scripts acquired Caremark a couple years ago. Recently, with our plan, they started capping ALL scripts at $75/90 day supply. (Used to be tiered) Also, having dexcom supplies available for refill after 68 days is nice if you want to build up a supply. One thing I’ve noticed, they’ll charge me $75 for one transmitter (90 day supply) unless I order a 30 day supply at a retail pharmacy ($30). There doesn’t seem to be the usual having to switch to the 90 day rx after 3 refills that they typically insist on. Hope that helps people with the insurance game!

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When I’m going hypo my lips tingle. Check his BG when he says he’s really tingling now, in case that might be it.

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I believe this is temporary due to the very high BGs he was experiencing. I had this, too, when my BGS were not under control and very high for prolonged periods. I rarely have the tingling now since I’m constantly monitoring with Dexcom and try to stay under 140.

I hope your son is feeling better. It sounds like you really got excellent care. Thank you for posting about the insurance, too, esp with all you are going through right now!!

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Absolutely no way.

When K was more recently diagnosed, he shook like crazy when he was low and sweated up a storm. It may be a similar kind of symptom?

I am really sorry :frowning:

But, as we all know here, it will not define who he is. He will live a normal life and he will be able to do everything they other kids do. My kid, and @Chris’s, do just that. I don’t even think their life expectancy will be much lower than glucose-normals, at the speed at which things are moving on.

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I’ve heard some endos say many T1s will live LONGER than average, due to their awareness of healthy choices!!!
I think even more so now, compared to T1s diagnosed 20-30 years ago. The number of 40-80 year Joslin medalists is growing faster than ever predicted.

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Might be part, but better insulins, technoligies and educational resources I would think are going to be biggest contributors.

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My “healthy choices” implied that, not just food.

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I just found this same thing out about my Dexcom supplies. I have BCBS/Anthem and put in an order with Edgepark and they said that the insurance company wouldn’t pay for it anymore. After calling BCBS I found out that it goes through the pharmacy now. However, I have to get another prescription from the doctor to get the supplies. When I tried to contact my doctor I found out he was no longer with the practice. I just saw him 3 weeks ago. So now I’m leaving messages and haven’t gotten anyone to respond.

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Well that is an ugly little surprise. Seems like the diabetes coordinators ought to be able to get another doctor in the practice to prescribe based on the visit notes. It isn’t like you are asking for anything that can be abused.

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A post was split to a new topic: Kaiser Permanente: Great insurance for T1 Diabetes