Once again, I am having a “waiting on Insurance” hassle with Walgreens regarding filling my Dexcom G7. The local Walgreens here in Florida is useless, so I drive to another city that has a Walgreens Specialty Pharmacy. They are much better at getting my G7s for me, but I now have waited over five weeks even for THEM to get the sensors through. Therefore…
I am going to change pharmacies to get my G7. I have a tip that Fairview Specialty Pharmacy out of Minnesota has their own diabetic prescription team, their own in-house Medicare team, and that I may be able to get a 90-day supply of G7s mail order with free shipping. Our summer home is in Minnesota, and we winter in Florida. Fairview said that they mail order prescriptions to all 50 states. Has anyone else heard of Fairview or had experience getting prescriptions filled through them?
Well, yeah, but there are very strict rules for CGMs through Medicare, and for non-disposable pumps for that matter (even stricter for pumps!) So if one pharmacy is waiting on your (Part C/MA) insurer then every one will.
I can’t remember the exact rule for how soon supplies can be ordered but it is certainly less than 5 weeks before the patient runs out with a 90 day supply. (21 days or 10 days I think). It is also necessary to have seen the doc within 6 months.
I’m on Part B (not Part C) and as a result I have to get my G7s from a DME supplier, Edwards in my case. Edwards have been pestering me to reorder for well over a month now but I knew that was pointless; they’d just sit on it. I waited until last week, reordered and then Edwards went to check I’d seen my doc (which I have because I see him every 3 months to meet the Medicare requirement for pumps). They then 2-day overnighted it along with an extra for some reason (maybe I was a bit late?)
So far as I know for Part C this all happens with your Part C insurer, not the supplier, and they do all the work with your doc. In other words I believe the Medicare rules apply on both Part B and Part C.
So the go-to place is your Part C insurer; because you have requested a refill it should be your insurer who is holding everything up and they should be able to explain why. (In my case it is Edwards because they are responsible for the checks.)
The rules are (@spdif , please correct me if I get this wrong…)
You have to ask (auto-refills are not permitted).
The provider (Part C: insurance, I believe; Part B: DME provider) must ensure that you have less than a certain amount of supplies left. I think Edwards just relies on the 10-day life of the G7 given a 90 day supply, i.e. add 90 days to the last delivery.
The provider has to establish that you are still using the CGM. I think Edwards just asks the doc.
The provider has to establish that you saw your doc within 6 months.
Only after they have done all that are they permitted to ship the supplies. On Part B if they ship too soon they don’t get paid by Medicare. Part C seems to work by having the insurance company do all the heavy lifting so there may be some flex around ship dates.
Private insurance (ACA, employer) is more relaxed and I could get G7 supplies through Walmart so long as it was 75 days after my last 90-day supply fill. Sadly but understandably this leads to us overstocking and ending up throwing the things away or not claiming replacements from Dexcom when the sensor fails after a few days.
I only saw a supply problem once with Walmart and it did concern the G7 but in practice they filled it within a few days. My wife had a supply issue with a medication prescribed in tablet form; she took an incredibly low dose and supplies were limited. She had to get a new prescription for a capsule.
I suspect part of the problem is that the large chains continuously battle the distributors for deals, so, yeah, if that is going on with your G7 a small chain may be better unless you lose a discount from your Part C insurer as a result. For commercial insurance swapping to mail order might be better; I’m moving to UNH next year for Part D and I do get better deals from their mail order options.
Part B will insta-approve a CGM refill. Its on the supplier, Walgreens in this case, to make sure they have the documentation you mention to survive a medicare audit. Wags outsources the documentation part and that’s who the store is waiting on. Changing pharmacies is a solid plan while Wags finishes falling apart.
@SherryAnn asked if anyone has used Fairview. Maybe @mohe0001 knows someone who knows about them.
John, you are not telling me anything I do not already know. I have been working with the Medicare rules for the last six years. My frustration is due to the following:
I NEVER get a 90-day supply. Through Walgreens, I can only get a 30-day supply, and that is fine as long as the paperwork is in place and no-one screws around with the order.
My last order I picked up on November 10. That means I should have been able to ORDER my December supply 10 days before December 10–thus, December 1. I always try to order at least within five days of the next “fill” date for my sensors.
I see my Endo every three months, so I always meet the Medicare 6-month “see the doctor” rule. I last saw my Endo Nov. 10.
I ordered my December supply within their time limit. Walgreens said I needed the doctor’s notes, so they supposedly sent the “form” to my doctor. She never received it. I followed up with the pharmacy who called Walgreen’s Medicare office and they supposedly sent a second form. Again, my doctor’s office never received it. A third follow-up with Walgreens and another call to the Walgreen’s Medicare office resulted in their office finally sending the “form” for my doctor to the pharmacy where I took it and hand delivered it to my doctor’s office. I was told she sent her notes back to Medicare the same day.
So now my December order once again caused lots of hassles. I had to call Walgreens again today to learn the progress of my order. The pharmacist had to call their Medicare office AGAIN to find out what the hold-up was. They informed him that they had my doctor’s notes, but they had not gotten around to processing it yet. they told him to call back in two hours, and they would push my order through,
Had the pharmacist not called yet again on my behalf, I am sure that my sensor order still would be pending insurance approval. Walgreens is sick of having to beg their Medicare office to get action on prescriptions, and I am beyond frustration at having to contact Walgreens three times over to get my prescriptions on a timely basis.
Medicare and my supplementary insurance will pay for the sensors 100%. Price is not the problem. I know that I am not alone on being frustrated with pharmacies and with following all of Medicare rules and still not getting prescriptions filled on time.
I will get to pick up my December order tomorrow, but now the whole process will get delayed in January because my December order will not get picked up until December 18.
Yes. The problem is with the Walgreens Medicare compliance unit housed somewhere overseas, not with the Medicare coverage itself. Before Walgreens will fill the prescription, their unit has to process the paperwork — including doctor’s notes— to be sent on to Medicare and my other insurance for payment. Somehow their faxes to the doctor’s office did not go through twice (who knows where the problem was with those transactions!) and then they needed three calls from the pharmacy before they processed the notes.
SherryAnn is correct, the problem is with Walgreens. I recently transferred all my prescriptions from CVS to Walgreens and all of a sudden, I could not get my Dexcom filled. The pharmacist told me it was their Medicare department and he would call them. The pharmacy tech told me it was my doctor’s office not responding to requests for information. Sigh.
Finally, my endo’s office set me up with Byram. They were wonderful. Sent my sensors out the same day. The CSR told me the root problem is that CMS does not want to fill CGM prescriptions through pharmacies. CMS wants patients to use DME suppliers only.
Up to now, I have resisted using mail order for any of my meds or DMEs because I live where it is very hot from May to September and the temperature in the back of delivery vehicles will easily exceed 150 degrees.
Are you on original Medicare (Part B) or Medicare Advantage (Part C)? You can tell because if you using Part C you will have an insurance company (not Medicare/CMS) as your primary insurance (and you will have had the opportunity to change that company earlier this month.)
My setup is the same; Original with a Medigap/supplement plan G.
I signed up for this in April 2025, when I turned 65. Before that (Jan-March) I used an ACA individual plan and got my G7s from Walmart. Earlier I have got CGMS (G6 initially) from Walgreens.
I carefully provided my full Part B information to Walmart for my first G7 refill. They filled it and said I had to pay some Disney amount because, “[My] insurance doesn’t cover it.” This is what, “The computer said.”
So I got the 'phone number of someone else in Walmart because we all know that Medicare does cover the G7. The kind lady I talked to told me very rudely that, “Medicare does not cover CGMs.” I pointed out that they had to be billed to Part B (not Part D) and she become more irate while insisting she was right.
So then I went back to Albertsons (Savon); I thought the one I went to was a RiteAid/Walgreens but it may have been CVS Pharmacy.
I very very carefully explained that I was on original rather than one of the new fruit flavours. No problem; I was assured that they (the particular pharmacy) provide G7s to people using Medicare.
However a few days later I got a telephone call and the person who had helped told me that, no, they did not do Part B, only Part C, i.e. Medicare Advantage.
In both cases this was coming from the pharmacy; no CMS involvement. Both pharmacies seem to have made a decision to not do the paperwork for new patients. Certainly this process took me weeks for something that I needed on a 10-day-by-10-day basis so it’s an effective strategy for getting rid of, or avoiding, patients.
Blaming someone else is pretty common in my experience. I had a blame ping-pong experience a while back between EdgePark and moda, my ACA insurance company, trying to get Omnipods near the end of the year.
In April there were lots of people on TuD and FUD who asserted that it was possible to get Dexcom sensors through pharmacies but it was nigh on impossible to get people to say whether they were using “original” or “fruit flavoured”. Given my Albertsons experience I deduced that the problem was Part B vs Part C; that fitted the facts though not the explanations/excuses/blame.
This also makes sense because someone has to do the paperwork. For Part B it is the individual provider/supplier. For Part C it is the insurance company; this is probably why Part C costs more and why the CMS likes it because the CMS ends up doing less work.
So far Edwards has been bearable. The initial sign up was fast because I spoke to a real human being, not a web page, and that human got the answers to those of the CMS requirements that I could answer including having a “receiver” for the G7. Later interactions via the web have been much less satisfactory but I know the answers to the questions now so that may help.
None of these is easy for Medicare users. I am on Medicare Part A/B and G with a secondary prescription plan. I use a DME and get 90-day sensor orders. It is a PITA, yes, I have to see my doctor every few months (3 months), they fax (fax, like fax) material back and forth.
And I have to stay on it. But I always get my sensors, I stay ahead, and it works out. I have had to go into the pharmacy twice, but each time they gave me an excuse and paid for it.
If I were experiencing these frustrations, I would no doubt switch to a third-party pharmacy and consider using a DME supplier. None of which are great, but not this awful.
I use AARP as my Pharmacy supplemental provider, and the DME is Byram. You might not be able to switch until next year.
I had absolutely no issues getting sensors through my local CVS pharmacy. When I switched from private insurance to Medicare, they processed my Dexcom through Part B with no problem, and, since I had already met my Part B deductible, there was no copay. Simple.
The main reason I switched to Walgreens is that CVS is no longer a preferred provider through my Part D plan, and I really do need to use a pharmacy that is preferred, not just in network.
This EXACTLY was my experience. I finally was able to get my monthly supply of G7s yesterday. That was after 3 attempts to get faxes to and information from my doctor and three phone calls from the Walgreens team to their Medicare compliance group – including one call where Person A transferred the pharmacy tech to Person B who told her that she did not know, but she would transfer her to Person A who could help her! I will give Walgreens one more try next month, but if they send me through the same hoop-jumping routine, I am finished with them.
Same here. Last year CVS suddenly was not preferred, and I could no longer get insulin through them hassle-free. I have not had trouble with Walgreens on any other drugs (other than they seem to have empty shelves and always have to order what I need from the warehouse), yet Dexcom always is a problem.
Remember when I crashed that car? Tressler was the one who flexed his patient advocacy muscles and told the state that they damn well better not revoke my drivers license. He’s a bad ■■■. Really easy to work will. I was referred to him by the head of ADA in MN. Some people say he hires bossy nurses. I think he’s just a bad ■■■ who is not intimidated by assertive women. He’s great.
Fairview is on the front page of the paper every day. There’s been trouble. They are fighting with UHG. I like to imagine Dr Tessler is behind it. I saw those U of MN docs viewing my LI page the other day when I was egging on the doctors into a state of revolt. I’m in a lot of trouble in this town, but so are they. https://www.startribune.com/agreement-will-keep-fairview-in-unitedhealthcares-network-for-2026/601547484
Does all the bad news add up to something bad enough that someone maybe shouldn’t switch to their mail order pharmacy services? Or are they big enough and patient-focused enough to insulate patients from the business problems for a while?
The state government has discussed getting involved to prevent collapse, but they haven’t said anything recently. They are actually kinda suspiciously quiet, of late.
I can’t say what’s going on down there. I can’t predict. Concerns over a continuation of patient care have certainly been raised. Those concerns have been on the front page of the paper.
Let me ask my diabetic friend Lynn. She may know more.
Lynn doesn’t sound that worried. She gets her scripts filled thru Fairview Specialty Pharmacy and says they are MUCH better than Express Scripts and that she would never change pharmacies.
She says she hasn’t experienced any issues and imagines that the state would prop them up if something really bad happened. She says that it would take more than an insurer being liquidated to make that hospital fail. She says that the state won’t allow that to happen, @spdif It’s a giant university medical center. That’s, like, where they send every pediatric cancer patient in the state. They can’t allow it to collapse over 100M
Ha! The guy in the car on the corner is better than express scripts. Talk about a low bar. Fairview won’t disappear, UHC will buy anything healthcare related, said with sarcasm.
Tell Lynn I said thanks, that was the gut check I was asking for. I just hope it helps SherryAnn.
I only have G6 sensors, but if she needs to borrow some, I’m here in Anoka. I’ll be back and forth into the cities if she needs a supply drop off over Xmas.
