Kickbacks and formulary exclusions for CGMs

My friend Scott Strumello, probably the smartest diabetes advocate regarding tech, costs and insurance policies, sent me the heads up below regarding costs and coupons for Dexcom and Freestyle Libre CGMs. I’m passing it on to you with his permission.

From Scott: I have been (putting it nicely) perturbed by the fact that my own insurance company (Aetna’s PBM Caremark) is receiving legally-exempted rebate kickbacks contingent upon “formulary exclusion” for any CGM that is not DEXCOM brand, which basically means Abbott Freestyle Libre.

Dexcom, for its part, offers a manufacturer coupon save “enabling patients to ‘Save $200 per 30-day supply of sensors and an additional $200 on each 3-month transmitter’ to buy Dexcom sensors (and transmitters for the G6) which it distributes via GoodRx and on its website at https://www.dexcom.com/en-us/savings-center-cgm-without-insurance/ which is a valuable work-around for anyone with high-deductible insurance plans, are uninsured (or on  Medicare, for that matter, you just cannot submit it as a Medicare claim to use the manufacturer coupon or reveal that you’re covered by Medicare, but technically, they are not legally entitled to know that anyway). But for anyone with commercial healthcare insurance, I was unaware of any such manufacturer coupon offered by Abbott for Libre. 

Then, I discovered they do offer one (see https://www.freestyle.abbott/us-en/private-insurance.html for more) “If you are commercially insured and asked to pay over $75 for two sensors”. Patients must call Abbott’s Customer Care Team by telephone at 1-844-330-5535 (Available Monday to Friday from 8AM – 8PM ET) and ask for its eSavings voucher. Within 24 hours, Abbott will email the patient a voucher.

That seemed to be comparable to Dexcom’s coupon offer. For example, the retail price for a box of 2 Libre 3 sensors was $118.51 at Costco Pharmacy. On a per-sensor basis, that reduces the cost from $59.26 per sensor to just $37.50 each. But it also offers patients a choice which they might not have had available before.

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

Thank you Scott for always looking out for us.

This is Type 1 diabetes, high and low blood sugars

Screen Shot 2015-02-06 at 4.06.34 PM

This was on Facebook. This is not my Dexcom, but it could be. What struck me is how so many of us are compelled to put our numbers up and share them looking for comfort, camaraderie and someone else who “gets it.” For when it comes to getting it, I believe much of the health care community is in denial. 

We cannot “control” blood sugars in people with diabetes who use insulin. That’s everyone with type 1 and some with type 2. But that frustrates health professionals; after all their job is to cure us, short of that to fix the problem – our up and down blood sugars. 

But that is the very nature of diabetes – fluctuating blood sugars. And even with 24/7 oversight, no matter how hard I work at it, trying to do what a normal functioning pancreas does, I fail. My brain simply cannot replace a normal functioning pancreas.

I wrote about this recently on The Huffington Post in “Type 1 Diabetes Fully Explained.” It went viral in hours. Hundreds of fellow Type 1s wrote to me saying how I had perfectly captured how impossible it is to perfectly control type 1 diabetes. 

It is time for us to agree that the norm of diabetes, intrinsically, its very nature is up and down blood sugars, especially for T1D and insulin-dependent T2s. 

It is time to accept this and stop trying to fight it and control it. I hate that word control. This doesn’t mean that we shouldn’t work at having blood sugars as often as possible in our target range, but let’s agree it’s hard and let’s agree we can’t be perfect at this and let’s sigh a collective sigh of relief. We deserve it.

Furthermore, creating goals is the wrong way to manage diabetes. Goals reinforce the idea that if we only work harder we can lick this beast. But we can’t. Goals reinforce that there is a perfect standard and we just aren’t working hard enough if we haven’t achieved it. 

Rather, what we should learn is what to do with our numbers in the moment, keep breathing, and have the knowledge and no self-blame to do it – and then smile because we did something good for ourselves.

Funny thing, but given that blood sugars fluctuate all day and all night, we are much better off to befriend our efforts, both strong and weak, and behead the doctor who tells us our numbers “should” be better.

I want people with diabetes to hear from their health professional:

“This is tough. You have a condition that requires a lot of work and vigilance. Some days you’ll do better than others. Don’t beat yourself up, instead do your best as often as you can and know that the very nature of diabetes is up and down blood sugars. You cannot do this perfectly because your body will be doing something unpredictable a good deal of the time. Just know this, accept this and keep breathing. I for one honor what you do living with this everyday.”