Here is Australia we have one of the best healthcare system in the world. However there is still little support for cgms. Not even private health insurance has coverage. It very expensive out of pocket (about $80 aud a sensor, roughly $55 usd) so it’s not very affordable for long term use. With the poor aud exchange rate at the moment this may seem not too bad in your currency, but trust me it’s expensive in local currency!
Is cgms covered fully in your country or subsidized?
Can you also indicate which area of the world you are in please.
Awh man. I wish I was paying that for sensors. Insurance is different for everyone in the US. I get mine “in house” as a perk from my county through the doctor’s office for those of us in the middle that can’t afford private insurance and also don’t qualify for government assistance health insurance. Mine is great for covering doctor’s visits for just a $7 US copay, and their favored prescriptions and DME don’t cost a thing. Unfortunately, CGMs are only covered for children, so I can’t get any assistance on those. I have to pay out of pocket, but it’s my only major health expense, so it’s not too terrible.
I pay just under $95 US per Dexcom G6 sensor and another $125 every three months for a new transmitter, and that’s actually a really good deal here going through a membership wholesale club (Sam’s Club), with a more expensive membership option that includes big pharmacy discounts as a perk. I also restart the sensors and can usually get a full month out of then, instead of the 10 days they’re supposed to last, which helps offset the price a lot.
I don’t think there are a whole lot of people in my shoes who would choose to pay fully out of pocket for the Dexcom G6, when the Freestyle Libre costs less. But for me, it’s been invaluable. There way it works with my T:slim X2 is life changing. My husband agrees, since it’s given him so much more peace of mind, too. I’ve scared the crap out of him more times than either of us care to remember. No more incidents like not being able to wake me when camping in the mountains because we didn’t know yet that high elevation crashes my BG. So we’ll keep paying the high price. It’s totally worth it.
My Medicare Advantage plan doesn’t cover my Guardian 3 sensors. Medtronic charges $70/sensor which should be changed every 7 days. However, I recharge my transmitter and get a second week out of my sensors.
For past six months, I have bought the sensors on E-Bay and Amizon for between $30 and $45 each.
Once I reach my $3,000 deductible, which I do quickly buying insulin, I pay $30 per sensor and $0 for the transmitters, for a total of $1,080 per year.
@tedos, are you aware that CGM (your choice of Medtronic, Dexcom or FreeStyle Libre) is now covered for free for Australian T1s under NDSS for anyone with a health care card, in addition to the existing cover for under 21s? https://www.ndss.com.au/products/
I’m in the USA and my wife works for a hospital system with generous insurance coverage. There’s no annual deductible, and for chronic illnesses like diabetes you can join a management program which gives you 100% coverage on all diabetes supplies (pumps, sensors, transmitter) and only $10 for 90 day supply of meds. That means I get about ten bottles of insulin for $10. It’s terrible knowing how much people out there struggle. At one point in my life I had no insurance and had to use the city free medical clinic to get my supplies, so I’ve been on both ends of this cockamamie Swiss cheese health market we have (it’s not a system at all). I really feel for people who struggle and have to ration insulin, for God’s sake. It’s inhumane.
As for countries whose health systems do not cover CGMs, that simply has to change. CGM is the driver of the next epic shift in diabetes therapy- insulin automation. Unless a cure happens soon, automated insulin therapy will become the standard therapy for testing type 1 diabetes. To deny that coverage is a bit like denying coverage blood testing strips when urine sticks are available. Especially with the Dexcom G6 (which eliminate fingersticks completely), the urine strip analogy is exactly on point.
In Australia do you have the Tandem T:slim x2 with the basal and bolus automation? If so, do they cover the pump but not the sensors?
I completely agree, but that’s reality. We do have CGMS (albeit a bit behind as G6 is not here yet but previous versions are) but I haven’t heard of any insurance companies covering it. My DE thinks it will never happen. There is government coverage for under 21s (this only came in a few years ago) but once you are over that age, you are on your own.
If you can’t afford to take care of yourself early on, the complications later down the track is only going to be more expensive for the health system.
I also pay $0 for my insulin and diabetes management supplies (pump, CGM, meter, etc). My employer (a hospital) doesn’t want people to not take life-sustaining meds so they decided a while ago that they would take care of this for people. I know I’m so blessed, but I know I’ll have a hard time finding another job like this if I need to. That is scary to think about. (edit: I’m in Ohio)
Good to read the total cost of the G5 (I’m still on the G4 and also pay out of pocket with left overs from Dmates with “benefits” … so it costs abit less). Plus I change out my batteries in my sensor myself, except last time, something went wonky with a slim G4, so I splurged on a new shiny G4 sensor, Sadly, the G4/G5 here in Canada and other parts of the word, us going to G6 and eventually G7. I’m part of a group called Faces if Pharmacare where not just diabetics but others without insurance coverage through workforce / private / government or province … fall through the cracks when it comes to carefully watching their pennies to live, We hope to get a National Pharmacare System that will help EVERYONE fairly. Okay, getting off my stand … #ADA2020 lately has me all pumped up … gotta love being able to attend virtually!!! No mask, no fear of Covid-19, no expensive air travel/hotel costs … win win !!
Insurance is billed $6750 USD, and I pay $243 for 3 boxes of sensors (each contains 3 sensors). This lasts me about 3 months. Transmitters are more. Insurance is billed $1499, and my portion is $525 for 2 transmitters. This is after my deductible is met. Insurance pays 80% (of a lower negotiated price w/ Solara/Dexcom) and I pay 20% of that price. Complicated, and not that great. Sensors end up being about $30, and transmitter about $250.
This is why comparing costs is not that easy. I have high-deductable plan, so cost before/after deductible being met is very different. And once Oop met, zero cost.
Agree! I looked online and had trouble figuring it out myself! I see earlier in the year the insurance was covering 90%, now only 80%, after the deductible which I believe is $2750, but could not find the exact figure online.
Aside from a small pump program funded through JDRF for at-risk and financially disadvantaged youth, there is essentially no public-funded pump availability in Australia. The majority of people here have their pump funded through private health insurance.
Dexcom G6 and Basal IQ were approved in March this year, and rollout of G6 to the minority of end users who self-fund their CGM was announced on Monday. It hasn’t yet been listed on the NDSS , which funds CGM for under 21s or people with a health care concession card.
The actual rollout of Basal-IQ pump upgrades hasn’t been announced yet and may well wait until G6 is NDSS funded.
As for Control-IQ, it hasn’t been approved yet in Australia so it’s anyone’s guess as to when it’s coming.
