I logged into my Dexcom account to order my sensors today and I had the below message:
“Did you know that your CGM supplies may be covered under your pharmacy benefits? Instead of ordering directly from Dexcom, you may be able to pick up your supplies at your local pharmacy. Depending on your coverage, your out of pocket expenses may be lower through pharmacy than your current copay for CGM supplies.”
Is anyone getting their sensors as a Pharmacy benefit vs Durable Medical Equipment?? First time I heard this was a possibility.
Mine used to be, when I had a PPO plan, but the premiums increased significantly. Now I have a high-deductible plan, and sensors can only be covered as DME.
However, even when I did get them as pharmacy, don’t count on the ‘local pharmacy’ to carry them. I had to mail order them. I checked with local pharmacies and could not find one that would/could get them.
I have BCBS, and yes, the sensors are pharmaceutical while the receiver and transmitters are DME. I get them from different suppliers: the accursed, inept Caremark for the former and the efficient and helpful Neighborhood Diabetes for the latter.
Mine are, apparently, covered through pharmacy and NOT AT ALL through DME. In fact, that has caused a huge, massive kerfluffle between Byram Healthcare and myself this past month as I was told it could be billed either as DME or Pharmacy and was quoted pharmacy prices, but opted to go DME, thinking it would be free as I’d met my max out of pocket for the year.
I was denied under DME due to my Type 2 status - but then someone at Pumps It told me if I’d gone through Pharmacy, it’d have gone through unquestioned and my insurance (also a version of BCBS) confirmed it.
BTW, if you really hate your supplier, the folks at Pumps It are WONDERFUL. They’re a smaller, Houston-based company. Only about 20 or so people work there. An actual human answers the phone - Rochellie is the receptionist. They have a single pharmacist, Mark, who is awesome. The owner of Pumps It apparently has close ties to the Texas Lions Diabetes Camp where Dr. Ponder (Author of Sugar Surfing) volunteers. I’m really looking forward to working with them once I get my stuff sorted out with Byram.
I have express scripts and i got my G5 reciever and sensors for 10 bucks through my pharmacy benefits. I pay 10 dollars a month for sensors and 10 dollars for transmitter every 3 months.
and my insurance (also a version of BCBS) confirmed it.