Is this a normal way to get a dexcom?

On 9/12/2018 I saw my endocrinologist and part of that appointment we discussed me getting a Dexcom CGM. They said they would check with my insurance to see what cost if any I would need to pay and get back to me.

Today 9/15/2018 (3 days later) a Dexcom G6 was delivered by UPS to my door. It says its a prescription with $0 co-pay prescribed by my doctor. It also says I have 30 days to return it. The company that sent it is “Health Link US” (never heard of them).

This situation is very odd to me. Is this a common way to receive a Dexcom? I was expecting someone to call or email me details on cost and how to get refills and for me to agree to it all before anything else happens. Normally I get my prescriptions filled from Walgreens. Health Link US appears to be a third party that fills prescriptions but I have no experience with this.

I logged into Blue Cross Blue Shield website and don’t see any prescription related to this. That makes me wonder if the cost will be 0 if my insurance hasn’t registered this yet? I’m worried there will be a cost and once I open the Dexcom I’m on the hook for the unknown cost.

If anyone has experience with something like this please let me know if this is normal. For now I’m not planning to open the Dexcom until I can at least call my doctor Monday to find out what is going on.

Thank you,
Chris

Dexcom is usually covered as DME, durable medical equipment, and is usually processed differently than insulin, pens, drugs, etc. Walgreen would not be able to supply dexcom sensors.
(Correction, I learned today that in some cases Walgreen can supply sensors).
Each insurance company decides which DME supplier they will work with. You may be able to search BCBS site for DME. Or wait until Monday to ask your employer for help if it is an employer plan.

For my sensors, I check to see that an EOB in completed status, and then I would know it is covered, and can verify what my portion is.

You are wise to be cautious, but also lucky to such quick turnaround if everything is legitimate. But I would confirm before opening.

Other thing is to check with doctor. Maybe they have some deal with the supplier, and charge it back to you with medical charges. Rare, but have heard that happens, for example if Dr wants you to do a trial run.

@ChrisP It completely depends on your insurance. For most Dexcom is considered DME. For some it is a pharmacy benefit. At first I could get sensors as a pharmacy benefit with copay, and transmitters as DME. Now my primary insurer is completely DME, and my secondary insurer is moving to a pharmacy copay. I have heard that Dexcom is trying to get more Insurers to cover as pharmacy to cut down on lead time.

CGMs are considered prosthetics, a.k.a. “Durable Medical Equipment,” which for many (most?) US health carriers aren’t supplied like pharmaceuticals but through companies that specialize in DME. So that’s why it isn’t done through Walgreens (though I’ve had my transmitters replaced via Walgreens, so go figure) but Health Link, which is a DME supplier. As to why they acted so precipitously, dunno, but the difference between inquiring and finding yourself already signed up is a fine one. One minute I was asking my endo about these insulin pump gadgets and the next minute I was signed up for the prep classes to get one. It’s like putting your foot on the first step of an escalator.

They definitely CAN supply Dexcom transmitters–I’ve gotten them through Walgreens (the one in the Joslin Center keeps 'em in stock). But I think you’re right that they don’t do sensors. God alone knows what the difference is. If anything you’d think it would be the other way around.

My secondary concern is what happens in January when my insurance deductible resets.

Our family has meet our copay for the year but in January what will the sensors/transmitters cost.

My company reimburses for prescriptions but I’m not sure if this type of thing (DME) is not the same in that it would be reimbursed.

I’ll contact my doctor and HR to get more details before getting started.

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Do you use an insulin pump? That would give you some indication of how it’s going to work. Pumps are DME too, though I think there are differences in which bits are considered prosthetic and which aren’t, depending on your coverage. For me (BCBS Mass) it’s all DME except the insulin.

This will depend on the very specific coverage definition of your plan. At one time I had an insulin pump covered as a $40 CO-PAY , until they caught the mistake of how it was set up in the system.

Your plan may include dexcom the same as medications, it’s less common, but possible.

Well the Joslin clinic just may get a higher percentage of diabetics and be able to file DME claims.

I tried to get Libre at Walgreen, and they did not have locally, but I know others have gotten them in other Walgreen locations.
The Libre seems to be closer to the blood meter category vs DME. I was able to get Libre with RX from CVS, but had to wait a couple days for it to come in, as they don’t stock them.

Yes–obviously the one at Joslin is a special case (the head pharmacist there is a T1 and uses a Dexcom). But I’ve gotten 'em through my neighborhood Walgreens as well, though there was a wait as you’d expect.

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No pump yet

Be sure to reorder at the beginning of December. You should be able to reorder sensors about 80 ~ 85 days after the current order was shipped.

My suggestion is to call in to reorder at 80 days (from the company that sent these) and ask if it is too soon to reorder. They will check and if too soon will say what day you can reorder.

That kicks the can down the road a number of months into the new year.

How many sensors and transmitters came with your initial order?

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If I had to choose between a pump and a CGM, I’d definitely go with CGM.

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I got a Dexcom Receiver, Transmitter, and 9 sensors.

Only one transmitter?

Great plan !

Just double checked, one transmitter with 4 refills over the next year.

Be sure to reorder in early December.

That’s certainly going to be the exception rather than the norm

Personally, would think a PUMP would be considered Prosthetics, instead of CGM. Lord only knows.