Medtronic sensors and insurance


#1

Can anyone please tell me if their guardian sensor three it is covered by a pharmacy benefit? I have been having a horrible time trying to figure this out spending hours on the phone with Insurance and device companies. When I was using a Dexcom the sensors were covered under Pharmacy and now the medtronic is not. Is it true that medtronic will not contract with distributors using the pharmacy benefit? Thank you so much I am feeling very frustrated.


#2

It’s been awhile since I used the original medtronic Sof-sensors, but they were always covered as DME, not pharmacy. Probably because typically reservoirs and infusions sets also needed to be supplied. A sensor that can only be read by the pump would make sense to be handled the same as pump supplies.

I switched to dexcom, which did not integrate with pump (minimed). And with one plan, this was covered under pharmacy. But now even that must be DME in my current plan.

If you have employer insurance, contact, HR to see if they can help determine if any of plans offered would do this.
Some employers get specific exceptions written into agreements with providers.