My insurance requires me to go through CVS Caremark for all my prescription medications but for durable medical equipment (DME) I go through a DME supplier that is in network with my insurance company for my Dexcom sensors and my Insulin Pump supplies. Maybe you should look in that direction. Hope this helps.
Hi. That's where I was originally headed. I called Dexcom and they told me to go through Neighborhood Diabetes to get my sensors because they were considered in network, but Neighborhood Diabetes is telling me the same thing that BCBS is telling me - that the actual Dexcom device is covered through BCBS as DME, but that I have to go through CVS Caremark for my sensors. I've called BCBS and CVS Caremark about 3 times now to clarify because it just doesn't sound right, but everyone gives me the same answer.
BCBS covering the device and not the sensors is like buying an oven and not having any pots or pans. And CVS Caremark not covering any of it is just ridiculous. Thanks so much for your suggestion though. Maybe I'll call back again tomorrow and see if I get a different answer.
Usually sensors aren't covered under your prescription drug coverage. Most plans consider CGM sensors "durable medical equipment" or "DME" and you'll have a separate benefit for that, usually as part of your medical insurance. I'd call up your medical plan and look into their coverage for DMEs and then find out if they cover sensors.
Hi Erin. Thanks so much for your suggestion. That's the odd thing about this situation. I've called BCBS three times now to see if they will cover sensors if they are billed as DME, but they keep claiming that because I don't have prescription coverage through them, only the actual device is covered through them, not the sensors, and the sensors have to go through my prescription plan - CVS Caremark.
I feel like I'm in a unique situation. Just wondering if anyone else is in this same situation.
Thanks again for responding.
I've had a similar situation. The Dexcom Rep was able to help identify a pharmacy option that worked in my situation, which is Foundation Care. Your plan may be different but you can see if Dexcom or Foundation Care can help.
The key issue with Caremark is that they need the 'NDC' number in their system, and maybe associated with your plan.
Hi. Thanks. So, I called Foundation Care, and all they did was confirm that CVS Caremark doesn't cover anything. How were they able to help you? Do you get your prescription care through them now? I'm confused regarding how they work because I thought they were going to give me more options.
Thanks so much!
Hi Steph - sorry FC didn't work out for you. Not all Caremark plans are equal, and depends on what your employer signed up for.
Can you check with your Benefits/HR dept or review the details of your coverage ? Look for details regarding diabetes supplies, that would include BG strips, insulin pump supplies, etc. If your employer's description of your benefits includes CGMS/sensors, then you might need help from your employer to get Caremark to cover it, either directly, or by mailing in claims. Or it may be that Caremark has your plan set up incorrectly in their system (it wouldn't be the first time - but I won't go there !).
You might also try to escalate your call to Caremark, to a supervisor, and ask if they can quote the specific details of coverage for your plan. Ask if they cover Minimed CGMS Sensors, and if so, explain that Dexcom sensors are the same, just a different brand. If supervisor isn't helpful, ask for the next higher level. (It's helpful if you can 'quote' what your plan says that deals with diabetes supplies, and why you think Dexcom sensors are included in that definition.)
Your employers plan may have an 'out of network' coverage for things not available via Caremark, but at a higher rate. Check your plan details.
See if you can get more help from Dexcom to find other alternatives. Typically they would have notified you if you were not covered, if you asked for pre-approval. Sounds like they told you Diabetes Neighborhood was a supplier, but did not actually confirm your plan benefits.