Dexcom G6 - BCBS NC State Health Plan

So apparently under NC’s State Health Plan (BCBS) CGM supplies are no longer covered. I have been using G6 for almost a year and insurance has provided coverage up until now and I assume the policy changed because now they no longer do. Anyone else experiencing this??

Also any experience with NC or TN Medicaid and their coverage of CGMs?

Did you speak to BCBS? If your coverage is changing, legally they have to notify you. It may just be a mistake with your provider though. My sensors got denied at Walgreens, they said it was no longer covered. I called UHC and they said my coverage had to be moved from pharmacy to medical, as part of the plan. They gave me a “transition of care” override, so I was able to get a 30 day supply from Walgreens, while they transitioned everything to Byram Health. Now I get it from Byram.

I have BCBS of NC, but, am not on state health plan. I haven’t heard anything about them not covering for CGMs. Maybe, it’s being changed in the way it’s processed. I would hope they would not be so cruel do discontinue coverage totally.

I’m covered by BCBS through SC State retirement plan. Haven’t heard anything here yet, about non coverage for CGM supplies.

I have a policy through BCBS of N.C. but it’s not the state plan. Under this particular plan, I just found out that there is a maximum pharmacy benefits and of course we have maxed it out! I’ve had this plan for several years and it’s never been a policy until this year. This is the first year we have had to buy diabetic supplies since my son was just recently diagnosed. I am going to have to switch policies and was thinking about adding him to my state plan but now I am weary! So ready for open enrollment so we can make some changes. He also is on the Dexcom G6 and I want to make sure he can continue using the cgm. It has made a world of difference!

Hi, I went to the pharmacy yesterday to pick up my daughter’s supply. They told me that the insurance was no longer covering humalog. Which surprised me. They said it would have to be generic. They told me they would be contacting me to let me know what else the insurance wouldn’t cover or if there would be anymore charges. Possibly the stripes and lantus.

Hello @M.Sanchez Mayra, yes the insurance companies may now or soon be rejecting “Humalog” prescriptions in favor of generic “insulin lispro” but it should not change much of anything in the world of insulin. The insurance companies sometimes reject coverage in favor of formulary (more favorable manufacturing) or reject coverage for cause. In the second case, you must appeal and push your doctors instructions in order to get coverage. In the old days, both CGM and insulin pump rejections were common, as were appeals and subsequent approvals. Sometimes you have to fight for coverage Good luck.

For Emma25. We recently moved from NM to FL and the BCBS coverage came with us. But the details of how the plan works varied considerably. In NM, BCBS Dex supplies were covered as a “Medical” benefit (I would get 2 transmitters at a time - every 6 months). In FL, it’s covered as a “Pharmacy” benefit (I get 3-month supplies only, so 1 transmitter). In my case, the Pharmacy benefit is handled by Express Scripts NOT BCBS. I wonder if that’s what’s happened in your case. I learned that detail from a BCBS rep who was quite helpful – beyond what they are “expected” to do, I’m sure. Perhaps you can get a helpful rep, too – or check with the employer rep in the state office. Someone will know the rest of the story.

In my case, the Dex system itself might still be a “medical” benefit. It’s the supplies that shifted.

(While I haven’t posted in years, I’m a LONG time JDRF volunteer & geek - and a longer time T1D)

Hi Emma
I don’t have experience in NC but when I was looking at switching to CGM’s last year I spoke with Medtronic and Dexcom directly. I gave them my insurance numbers and they actually did all the legwork to figure out how to get me covered. With my BCBS plan in New Jersey the sensors pump and infusion sets are not covered under my prescription plan but they are covered under my medical plan as durable medical devices…
Good luck
Mike

Yes we just went through the same thing. You are able to get everything through Express Scripts. Just call ES and have them call your current diabetes supply provider and get RXs transferred. We never received any notification from State Health Plan if the changes. Hope this helps.