Coverage of Dexcom G6 CGM Now Improved with TRICARE
Dexcom recently announced that its continuous glucose monitor (CGM)—the G6—will be included in TRICARE’s pharmacy benefits brand-name formulary. This will simplify accessibility via military treatment facilities, retail pharmacies and home delivery via mail-order. The Dexcom G6 was previously only available through durable medical equipment, which is filled by a third party and can vary in delivery time and cost depending on your insurance plan.
Effective mid-April 2022, the cost of a G6 CGM for eligible members may range from $38 to $0 per 30-day supply, depending on where the prescription is filled. With the G6 CGM now being covered under pharmacy benefits, members may now get their CGMs faster and for a more consistent price.
The Dexcom G6 CGM consists of two parts: a short, thin wire-like sensor that is inserted at home into the skin, and a transmitter that sits on the surface of the skin. The CGM continuously measures blood glucose levels and sends the readings to a small handheld receiver or your cell phone via the Dexcom CLARITY mobile app.
CGM Technology: a Gamechanger for Life with Diabetes
Having this data at your fingertips—without having to actually prick them—has been a gamechanger for people living with diabetes! Today, two CGM technologies lead the way: Dexcom and Freestyle.
The hour-by-hour burden of diabetes management on daily life can lead to diabetes burnout. These daily responsibilities include adjusting insulin doses based on blood sugar level readings, dosing insulin for food, preventing low blood sugar levels during physical activity, sleeping safely throughout the night without life-threatening blood sugar fluctuations and much more.
Using a CGM has helped to relieve some of the immense stress that comes with these daily responsibilities and decreases the overall safety risks people with diabetes face.
Studies have collectively shown that the use of a CGM for both type 1 and type 2 diabetes helps reduce the risk and frequency of hypoglycemic and hyperglycemic events, as well as lowers A1c levels.
Getting real-time measurements around the clock means people with diabetes finally have data on how their blood sugar levels change while they sleep; an option never available before.
CGMs provide extensive reports that tell both the person living with diabetes and their healthcare team what their blood glucose trends look like, their average blood glucose levels, and their overall time-in-range.
This data then allows a person’s healthcare team to make meaningful and imperative adjustments in their insulin dosing regimen and support them with other recurring blood glucose concerns.
CGMs are the New Standard of Care—But Not Everyone Has Access
Regardless of how much value, safety and improvement in overall health a CGM provides people with diabetes, too many people still do not have access to this technology.
This stems from both insurance provider eligibility and healthcare providers prescribing decisions. And of course, the cost of this technology even with insurance.
There are still different views in the healthcare field on who should be prescribed a CGM. Some endocrinologists will only prescribe a CGM to individuals who need more help managing their blood glucose levels. But regardless of how “well” you are managing your diabetes, every person with diabetes should have access to this medical technology.
Another obstacle to CGM access is the limitations established by insurance companies. Some insurance providers will only cover the cost of a CGM if the person 1) uses insulin, and 2) injects at least three times a day. This creates a barrier for anyone who does not fit these criteria regardless of their blood sugar levels.
If you are fortunate enough to have access and coverage for a CGM, the copays may still be too expensive.
Insurance providers may also have a preference for one brand of CGM over another, limiting which CGMs you have access to. Depending on the components of the preferred CGM, the cost may be out of reach for many people to afford separate sensors and transmitters.
- Read more about getting access to CGM technology.
For current and past members of the military, and their families, getting a CGM will be a bit easier starting in April 2022. Abbott’s Freestyle Libre 2 was also recently announced to be covered under TRICARE’s brand-name formulary, increasing the number of CGM brands available to military members and their families.
If you or your loved one is a member of TRICARE health coverage and is interested in obtaining a Dexcom G6 CGM, make a reminder to call your doctor or schedule an appointment this April to get a prescription for one.