So we are in Florida for a few weeks and I thought that while we were here I would try to create a US Dexcom account and order my daughter some sensors since they seem a bit cheaper in the US.
Except I found out that I can’t because you need a US doctor’s prescription to order Dexcom… say what? In Canada you don’t need such a thing, you just call and create an account and order them. We pay for them out of pocket so conceivably anyone in Canada who wants to wear a Dexcom can buy one so I just assumed it would be the same here.
But why on earth a prescription? It’s not a medication! Do you also require a prescription for pump supplies in the US?
That’s a good question. It’s easy to understand for safety reasons that medicines need a prescription with the implied doctor consultation. There are also addictive medicines that need the control of a doctor and pharmacist to protect people.
I’m trying to think of how a Dexcom sensor could be misused if sold without a prescription. I’m coming up empty on that one! Sometimes various vested interests in the US, like doctors associations and large pharmaceutical companies, can influence legislation that suits them and not so much the average citizen.
That might be the medical vs pharmacy benefits of your insurance?
Dexcom (the company) has been working to get the Dexcom to be covered as a pharmacy benefit for quite a few years now. (Speaking of the US - no idea how other countries work). They have had some success such that in certain areas of the country with certain insurance carriers, the Dexcom cgm will go against your pharmacy benefits.
This switch to pharmacy has been slow and not as rapid as Dexcom would like.
In the U.S., Dexcom supplies is typically billed under medical as durable medical equipment (DME), not prescription. The name is a misnomer though because neither pump supplies nor cgm supplies are all that durable (sensors are discarded in 1-2 weeks and insertion sites within 3-4 days). Perhaps it makes sense that transmitters and the actual pump are billed under DME.
Unfortunately, my cgm supplies is the only benefit I use that is subject to the medical deductible. It’d be nice if this were billed under pharmacy instead. Strangely, my insurance plan’s formulary does list Dexcom even though it’s billed under medical.
oh @mohe0001 you are so kind! But I just put a new sensor in and it should last till we get home. If not we will just go without. I will order some back home so that they will be there when we get back. I pay $340 Canadian for a box of 4 sensors, which is roughly around $265 US. Am I right, is it cheaper to buy them here?
After reading all your posts it would make sense that Dexcom would like it to be covered as a pharmacy benefit so that Insurance companies would have to cover them. If that’s the reason then now I wish that we had to get a prescription for them in Canada!!
Because we have our socialized heath care in Canada, if you have insurance it just cover’s the ‘extra’s’ that our heath care doesn’t provide. But most insurance companies won’t cover CGM’s likely for that very reason, they aren’t doctor ordered. Now your dr can write a letter you can give to your insurance company saying that you need one, but even that won’t force an insurance company to cover it.
Now our family doesn’t have extra insurance at this point, and even if we decided to pay for our own insurance coverage out of pocket they can refuse to cover Sarah because of her pre-existing medical condition, so we just go without. But thankfully since January, our heath care now covers prescriptions for children up to the age of 25 so at least we don’t have to pay for insulin or test strips!
I had a plan one time where dexcom could be covered as pharmacy or DME. It was based on how my employer defined the plan. There was a ‘diabetic kit’ rule, and dexcom was considered to be part of the kit when ordered all at same time as pharmacy, thru mail order Caremark, with single copay. It was a GREAT deal. But they figured that out and changed dexcom to be DME instead of part of kit, so employee paid more, employer paid less.