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.

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