December 15, 2022
Medicare: Continuous glucose monitor pharmacy availability
CGM to be available through pharmacy point-of-sale starting Jan. 1, 2023
To help improve member access to these products, continuous glucose monitor (CGM) supplies (transmitters, receivers/readers and sensors) will be made available through the pharmacy at the point-of-sale.
Effective Jan. 1, 2023, coverage will be available for the following products at the pharmacy:
- Dexcom G6 receiver, transmitter and sensor
- FreeStyle Libre 2 reader and sensor
- FreeStyle Libre 14-day reader and sensor
CGMs were previously available for UnitedHealthcare® Medicare Advantage members (Individual, Employer Group and Dual Special Needs) only through national durable medical equipment (DME) vendors. Members will still be able to access these CGMs through a national DME vendor.
Things to note
- Members need to satisfy Centers for Medicare and Medicaid Services (CMS) criteria to purchase CGM supplies through the pharmacy at the point-of-sale or a national DME vendor
- The member’s Part B cost share under their plan is the same whether the CGM is obtained through a DME or through the pharmacy at the point-of-sale
- If the member’s use is not consistent with CMS criteria, prior authorization will be required and managed through the pharmacy benefit manager (PBM), Optum Rx®
Questions?
If you have questions about a member’s CGM coverage through the pharmacy, call the number on the member’s ID card.
