Insurance about Insulin Pen Needle and Dexcom G6

Hello Everyone,
It is great that our T1D folks can meet here and ask questions. As a parent of newly diagnosed T1D, I did not-too-bad-job to take care of his diabetic needs. Now I finally get time to looking for answers for some questions about the diabetic care. My insurance got confused about cover the cost of Insulin Pen needles. Customer supports from my insurance told me that insulin pen needles are categorized as diabetic device, but the pharmacy told me they are in the pharmaceutics group the same as insulins. This makes big difference on the cost of getting insulin needles. Right now, I pay $50 for 100 counts needles. I would like to know what category of insulin pen needles belong to and how to get more affordable pen needles.
Dexcom G6 costs $300 co-pay for one-month-supply but I do like their technical support.
Thank you and I wish we all stay strong!!

Hi @Glucosebee and welcome to the forum. I use a pump - not pens - so can’t directly answer your question, but - a few months ago I had an issue with coverage on one of my meds. I spoke with an insurance rep and they adjusted something on their end, ran a test to see if it would go through, and offered to contact my pharmacy for me.
I’ve tried “running interference” between insurance and my pharmacy and ended up with a big headache: insurance said the item needed to be coded a certain way so it sounded like a simple matter of relaying that to the pharmacy. But other things needed to be in place for them to apply the code and it was not as simple as it sounded. I’ve found it’s best to have the insurance contact your pharmacy or provider (or vice versa) directly: they speak the same language and can usually resolve things quickly.

Hi @Glucosebee! I use insulin pens and pen needles. I don’t have insurance, but I have had success getting insulin pen needles off of Amazon. I would read the reviews. They regularly have BD pen needles for less than $20 a box (100 needles). I found that I like the medfine 32 gage 4mm needles. Also, I use the Freestyle Libre. It is a CGM and costs me about $75 a month. I have my doctor send the prescription to Walmart. I hope this helps!

Hello Glucosebee and welcome to the Forum! There are many T1D’s here who are happy to help!
From my experience, pen needles are usually covered under medical equipment, but are purchased at the pharmacy, with a prescription. Brands vary, and most insurance companies cover certain brands with a lower copay than other brands. This varies by insurance company and plan. So, the best thing to do is to contact your insurance company and ask what the preferred brand is for your plan. Either you can call, or your child’s doctor (endocrine).
As far as the CGM goes, the same is also true, that the plan will have a preferred brand (this is also true of brand of insulin, syringes in pumps!). If you/the doctor feel that Dexcom is the best for him/her and it is not the preferred brand, you/your doctor can submit for what is called a Prior Authorization from the insurance plan to have it covered at the same rate as the preferred brand. This simply entails the doctor submitting records showing the need for this item. Also keep in mind that you will pay more out of pocket until your deductible is met, So, if Dexcom is already a preferred brand, this could be why your cost is high right now.
Your best bet, is always to check with the insurance company to see what they cover and at what rate of copay. The copays are usually in 3 tiers, with the tier 1, or preferred brands, being covered at a higher rate by the insurance. Each of the other tiers, you would pay more of the cost, increasing as the tier # gets higher (IE: you pay the most out of pocket for tier 3 meds/supplies). If your cost is too high, talk to your doctor to see what your options are. Change brands? or File for Prior Authorization to try to bring the cost down (IE: get the insuance to cover it at a lower copay)?

Hope this helps!

Pam, K.
T1D 57.5 years and counting!

Thank you, my friends! You are hero. All the information you shared with me and here are helpful and valuable. All your support helps my son and myself go through this first month of the diabetic care.