Kickbacks and formulary exclusions for CGMs

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.