CGM kickbacks and formulary exclusions

A friend of mine scott strameloPerhaps the smartest diabetes advocate when it comes to technology, cost, and insurance policies, he sent me the following notes on Dexcom and Freestyle Libre CGM costs and coupons. Delivered to you with his permission.

From Scott: I am told that my insurance company (Aetna’s PBM Caremark) is receiving rebates for legally exempt rebates provided they “formally exclude” CGMs that are not DEXCOM branded. I’m upset (to put it nicely) by the fact. This basically means: Abbott Freestyle Libre.

When purchasing the Dexcom sensors (and transmitters for the G6) that it sells, Dexcom says, “Patients can save $200 on every 30-day sensor supply and an additional $200 on every 3-month transmitter. ” offers manufacturer coupons. Via GoodRx and on its website https://www.dexcom.com/en-us/savings-center-cgm-without-insurance/ This is a valuable workaround for people with high deductible insurance plans, those who are uninsured (or those on Medicare). You can’t submit it as a Medicare claim to reveal that it’s covered by Medicare (but technically they don’t have a legal right to know that anyway). But for someone with commercial medical insurance, I didn’t know that Abbott offered such a manufacturer coupon for Libre.

Then I discovered that they offer it (see) https://www.freestyle.abbott/us-en/private-insurance.html Details) “If you have commercial insurance and are asked to pay more than $75 for two sensors.” Patients must request an eSavings voucher by calling Abbott’s Customer Care team at 1-844-330-5535 (available Monday through Friday from 8 a.m. to 8 p.m. ET). there is. Within 24 hours, Abbott will email the patient a voucher.

This seemed comparable to Dexcom’s coupon offer. For example, the retail price for a pack of two Libre 3 sensors at Costco Pharmacy was $118.51. This reduces the cost from $59.26 to just $37.50 per sensor. But it also offers patients options they may not have had before.

I blogged about it https://blog.sstrumello.com/2023/12/abbott-gets-real-about-formulary.html.

Scott, thank you for always looking out for us.