health

Kickbacks and formulary exclusions for CGMs

/ rivagreenberg / Leave a comment

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.

Tech doesn’t allow you to control blood sugar or diabetes

/ rivagreenberg / 2 Comments

I was a very happy user of the Dexcom G5 and G6 CGM. If you read anything here you likely know I’m not a fan of the G7 – too many lost signals and that atrocious overpatch. So several weeks ago I switched to Abbott’s Libre 3 and frankly it’s working pretty great so far. Yes, there’s an occasional lost signal, but far, far, far fewer, it’s just as accurate for me as Dexcom, so tiny that I forget I’m wearing it, and it uses the smallest amount of adhesive that’s also the strongest. It stays on throughout the entire 14 day wear.

However, while I think the CGM is the best thing to have happened to diabetes after the discovery of insulin, it does not, in any way, shape or form, control it. Or allow you to control it as the ad above indicates. What it does do is expand your ability to influence and navigate, aka manage, your blood sugar: nothing “controls” blood sugar or diabetes because it cannot be controlled.

Thinking we can control blood sugar and our diabetes takes the view that the human body – you – are a machine. As in you can do this and that will happen, precisely. As if I could get a blood sugar of 168 mg/dl down to 100 mg/dl exactly and in a certain time period. As if I could prevent toppling over 140 mg/dl by eating low carb and exercising, which I do, yet I’ve seen my fair share of highs and will continue to.

As a human, with multiple metabolic functions interacting and influencing blood sugar, and as I, and you, daily interact with our often unpredictable world, control is just not possible. So why do we keep telling people to take control as Dexcom assures us you can do with their CGM? I’ve recently written about this in further detail and will post the article here when published.

Meanwhile I’m glad to know “control” has been singled out for phasing out in the #languagematters movement. It’s time we get earnest about it and not continue to set people up for failure giving them the impossible goal of control.