Does NC State Health Plan cover Dexcom?

I am currently a state employee in South Carolina, which provides excellent coverage for diabetes supplies - Omnipod & Dexcom are covered in full. I only pay a co-pay for insulin. We are looking to retire to North Carolina, where I qualify for health benefits from prior employment there. But I am 5 years from Medicare eligibility. The NC State health plan appears to cover Omnipod as a Tier 2 item on the formulary, but I don’t see Dexcom listed. Dexcom customer service rep told me “no” but he seemed confused about what I was asking (kept referring to Medicaid) and I just find that hard to believe. Anyone have personal experience with this? (Plan customer service would not provide coverage information to anyone not already covered.)

@BugsNBones, did you ever get an answer to this question. Sharing is how we all learn.

Formulary typically list pharmacy only, and Dexcom may be covered as DME only under plan you are looking at.

Is there a website or phone number listed for plan you are looking at? May need to contact them to ask.

The NC State Health Plan was not able to provide any information on benefits until I was a member. Now that I finally have coverage under the plan, I have determined that MM1 is correct. Dexcom is covered under the durable medical equipment benefit. However, deductible ($1250) must be met and coverage is subject to co-pay of 20% (I have the 80/20 plan). I also have a co-pay for Omnipod through the pharmacy benefit. NC does cover insulin in full, which I appreciate. Novolog or Fiasp only; Humalog is not covered. Although I am happy to have some defrayal of cost, I am disappointed that the North Carolina plan for state employees and retirees is so inferior to the South Carolina plan, which covered Dexcom and Omnipod supplies in full (no deductible or copay).

Glad to hear you got the info you needed. Dexcom has been trying to get more insurance to switch to pharmacy, and lucky for me that mine did last year. Cost slightly lower, but convenience 200% better…

1 Like