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FYI I just learned something from Dexcom if you get it Pharmacy RX instead of DME

Discussion in 'Parents of Children with Type 1' started by mmgirls, Mar 13, 2014.

  1. mmgirls

    mmgirls Approved members

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    I was just on the phone with Dexcom asking them about possibilities of getting a CGM for my "impaired glucose" second daughter that is not DXed yet,

    They told me that the endo can sign off on a RX without a medical DX for the Dexcom if getting it thru Pharmacy RX. What she told me next was surprising. If I get the Dexcom thru Pharmacy RX I can "fill" that RX as often as I want and do not have to wait till 6 months on the transmitter to pass to order a new one.

    I wish I knew that at the end of last year!!! when we were getting them thru Pharmacy Rx I would have gotten an extra receiver that has audio! I hope my I can get it thru Pharmacy RX with my new insurance carrier. Crossing my fingers.

    (I am not advocating anyone using this loop hole to hoard G4's or anything. But having 2 working transmitters and receivers is absolutely wonderful to not have the 2hr warm up, or having a receiver one on your child and one with you at active ties. I also see having multiple receivers to be used with the Share dock to be a benefit)
     
  2. joy orz

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    How do you get Dexcom through Pharmacy RX?

    I just found out our new insurance has a $4000 deductible for durable medical, but pharmacy is covered. This loophole would be great!
     
  3. Megnyc

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    I replied in your other thread but I use foundation care pharmacy (mmgirls recommended it). Everything ships directly from dexcom or the pump company but they are able to bill it as pharmacy.
     
  4. mmgirls

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    Someone recommended to me Foundation Car Pharmacy when our "contracted DME rates" doubled when we switched carriers.
    It is a "Brick and Mortar" pharmacy that also does DME supplies, since they are a real pharmacy they can bill under RX, unlike Express scripts or Caremark. I was getting Dexcom/Animas/Omni pods last year for my $15 dollar RX copay instead of DME 20% of a contracted price. I just got my new insurance policy cards and I am hoping that they will still be able to work with me, They are wonderful!!! Good luck.
     
  5. joy orz

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    OH I could just KISS you right now! Wow! I will give them a call. I was not expecting to come up with an extra 10 grand this year. Good golly!
    Thanks so much. I'll keep you posted!
    Joy
     
  6. joy orz

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    Spoke too soon. Not covered. I could just cry right now. Neither pump supplies or Dex are covered. So I am looking at $800 a month in DME out of pocket. Can NOT believe this.
     
  7. mmgirls

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    Not covered thru Foundation care? Did you call Foundation care, because talking to the insurance company never worked for me. I was actually very surprised that it worked for me!

    Neither pump supplies or Dex supplies not covered by who?
     
  8. Don

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    Joy, $800 a month would most likely hit your Out of Pocket Max. I strongly agree with Meg's advice that you find out your OOP max. It wouldn't be as good as coverage under pharmacy but at least all medical expenses are free once you hit your OOP max.
     
  9. Wren

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    To get a sensor to transmit to 2 receivers, do you just start a sensor one one receiver and then repeat the "start sensor" procedure on the second receiver?
     
  10. hawkeyegirl

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    Yes. (message too short)
     
  11. Don

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    Is getting Dexcom covered as Rx simply a matter of finding the right pharmacy? Seems to me the real obstacle is whether your insurance company allows Dexcom on its drug formulary. What's the incentive for insurance companies? Is Aetna the only one? Sure, you need a pharmacy (Foundation Care, Express Scripts???) that is able to bill as Rx with the correct NDC but what's to stop insurance companies from refusing to cover Dexcom as a drug/disposable?
     
  12. Ali

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    I can not figure all that out either.
    Ali
     
  13. Megnyc

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    I have Aetna POS with express scripts for rx coverage. I'm not sure if other insurances allow it. The problem is that not a lot of suppliers that carry dexcom can bill as pharmacy. Foundation care and diabetes specialty center were the only ones that I found that can bill express scripts as a retail pharmacy.
     
  14. mmgirls

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    To me yes it seems like it depends on two things, whether the pharmacy can dispnse under prescription with does not need a medical DX and whether the insurance company has the N.D.C. listed as an R.X. item.

    I will find out this week if I can still do this on our new insurance.

    Fingers crossed!!!
     
  15. Don

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    fingers crossed for you. Rx is a lot cheaper
     
  16. MomofSweetOne

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    Not necessarily. It all depends on your plan.
     
  17. mmgirls

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    BOOOOOOO

    new insurance does not have Dexcom on RX. I hate that I did not know when we did have it RX on our last insurer.
     
  18. caspi

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    Our insurance doesn't allow Dexcom or Omnipod through pharmacy either. :(
     
  19. Don

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    There's probably only 5 people in the country getting coverage under Rx, lol.
     
  20. mmgirls

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