What To Do If Insurance Won’t Cover Your Insulin Or CGMs For Type 2 Diabetes

Living with type 2 diabetes (T2D) often means using supplies like insulin, blood glucose meters (BGMs), test strips, continuous glucose monitors (CGMs), smart) pens, GLP-1s, other blood-sugar-lowering medications or insulin pumps. Getting your health insurance to pay for these can be hard sometimes, even though it shouldn’t be!

If you’re having trouble getting your insurance to cover your T2D medications or supplies, this guide explains what to do. While it’s a bummer to have to navigate this, it’s unfortunately not uncommon, which is why resources like this are vital for overall management!

In this guide, we cover how to get insulin, test strips, meters, CGMs and insulin pumps covered by your insurance and when to involve your healthcare provider (HCP) for additional support. Let’s start by walking through how to check whether your insurance covers your preferred insulin(s)!

Need insulin with T2D? Check your insurance formulary first

Not everyone with T2D uses insulin, but if you do, you may encounter coverage issues. This isn’t rare and is a known issue among people with T2D. If your insulin isn’t on your insurance formulary or only covered at a higher out of pocket cost, it can increase your pharmacy costs. (A formulary is a list of drugs your insurance plan covers. It’s sometimes called a drug list.)

Don’t rule it out before you do a little digging, though! If your HCP recommended insulin, that’s something you can’t ignore. If you’re unsure whether your insurance covers insulin for your medical condition, the first step is to check your health insurance provider’s formulary. 

Here’s how to check yours:

• Visit your insurance company’s website or call them directly. Calling may give you more straightforward answers, even if the wait times on the phone are long.
• Ask your HCP’s office if they can help you check your formulary, since many clinics have staff who handle this. Enlist the experts so you can focus more on what you need to do.
• Use your patient portal to message your HCP about this instead of waiting for your next appointment.

Find out what insulin is covered on your insurance website

Many insurance websites have a pharmacy benefits search engine—sometimes you can find medication coverage information on a page called a “medication checker” or “request an Rx.” It will always show you the price before you order, so don’t worry. 

You can enter a medication name to see its cost, which pharmacies carry it and whether your plan covers it. For example, if your HCP recommended Humalog or Lantus, that’s what you’d type into the search engine.

While each insurance website is a little different, here are some general steps to help you get started:

1. Find your insurance plan’s drug cost and coverage tool.
2. Search for the drug you want to check.
3. See if it’s covered

If the insulin shows up in your search, you’ll usually see the cost, nearby pharmacies that carry it and whether mail order could save you money. If the drug doesn’t show up, or it’s listed at full price, this may mean it isn’t covered or you’ll need something called a prior authorization, which we’ll explain later in this guide.

Of course, if you’re having trouble affording or accessing insulin, regardless of your insurance, GetInsulin.org has resources to help. No one should be without the medications they need to survive and thrive with diabetes. 

You may qualify for affordability or assistance programs that can make insulin a little more affordable and accessible through medication manufacturer or patient assistance programs.

Getting insurance coverage for test strips and BGMs

Some insurance plans limit how many test strips you can get during a certain time. If you test more often than your plan allows, you could end up with a big bill.

Check your plan’s formulary and testing supply policy to see what’s covered. Call your insurance and tell them the brand and amount of test strips your HCP prescribed. If you run into issues, this could mean that you will need to use a mail order program to lower your copay. Ask your insurance for specifics like brand, pharmacy or supplier covered. It also helps to talk to your HCP about how often you really need to test.

If your insurance doesn’t cover enough test strips, you have other options:

• Buy generic test strips over the counter, without using insurance. It won’t apply to your insurance deductible this way, but it will save you money upfront!
• Look into a test strip subscription program, which often lets you order as much as you need.
• Check if that same subscription program also offers a BGM.

The same logic goes for meters. Store brands sold at places like Walmart, CVS or Walgreens often work just as well as name-brand meters for a lot less money.

Getting insurance coverage for CGMs and insulin pumps

It can be harder to get a CGM approved for T2D than for type 1 diabetes, but a CGM can still be a great tool for managing your glucose. 

If you’re having trouble getting one covered, use these resources:

• Freestyle Libre free trial program: lets you try the Freestyle Libre 3 Plus, a 15-day sensor, for free if you qualify.
• Abbott: offers insured and uninsured coverage guidance including a copay card if you qualify.
• Dexcom free trial program: lets you try the Dexcom G7 for free if you qualify.
• Dexcom Pharmacy Savings Program: lets you use a coupon to save on cash pricing of Dexcom products, must have a CGM prescription.

Over the Counter (OTC) CGM options for people with diabetes not using insulin: 

• Dexcom Stelo: available as a monthly subscription, Health Savings Account (HSA)/Flexible Savings Account (FSA) eligible and integrates with several apps. This CGM is best for people with diabetes who do have hypoglycemia (low blood sugar) events.  

Getting insurance coverage for insulin pumps with T2D

Insulin pumps can also be hard to get covered when you live with T2D. Costs and coverage vary by insulin pump brand and insurance plan, and you may need a prior authorization for either a pump or a CGM. 

If you’re feeling stuck trying to figure this all out, we get it—try calling the company that makes your device. Their representatives often know the most about coverage problems and how to solve them.

If your formulary isn’t the problem, loop in your HCP! 

Insulin pumps are considered durable medical equipment (DME) and may need to be billed and ordered differently than medications typically available through the pharmacy. Coverage varies, and some insulin pumps might also be considered part of your pharmacy benefit. This can be the case with CGMs too. Your insurance company, pharmacist and HCP can explain this to you and help you find a way to get what you need within your insurance guidelines.

When to loop in your healthcare provider to support you

If you’ve checked your formulary and coverage is still an issue, it’s time to involve your HCP. They may need to write a letter to your insurance company or speak with a representative directly.

You may also need that handy-dandy prior authorization. A prior authorization is a request your HCP sends to your insurance company to show that a medication or device is medically necessary. Your insurance company can tell you what’s needed to submit one, or your HCP’s office may handle it for you.

Before you submit a prior authorization, keep a few things in mind:

• Make sure the prescription matches the amount of insulin or supplies you actually need. This should be a decision you and your HCP make together.
• Your HCP’s office should be willing to push back if your insurance denies the supply amount you need. They’re part of your team, and they should help you get approved.
• If you have insurance, you may also qualify for copay cards that lower your pharmacy costs.

Needing insulin or other tools to manage T2D is nothing to feel ashamed of! These are simply the tools that help you live a healthier life.

Never stop advocating for your health with T2D

This article covers only the basics of managing insurance while living with T2D, as individual circumstances and coverage vary widely. As new issues arise, keep your insurance company, HCPs, pharmacy and anyone else involved in the loop. They should be part of your support team. If no one is helping, it may be time to find someone who will.

You don’t have to stay stuck with a HCP or within a healthcare system that won’t advocate for you.

Self-advocacy is a key part of your T2D journey. Never stop fighting for yourself, what you need to manage your health or your worth as an amazing human living with a challenging condition!

Need support navigating the ins and outs of life with T2D? It can be a lot to manage on your own, and you don’t have to do it alone! Join a community that just gets it—be part of our Community Apps.

This educational resource is made possible through the support of Abbott Diabetes Care. Beyond Type 1 retains complete, independent editorial control over all content.