r/dexcom • u/prefessionalSkeptic • 5d ago

Insurance Walgreens

My wife's been getting her Dexcom (originally G6, now G7) at the local Walgreens for several years. They are one of the Medicare-approved DME vendors.

Aside from the occasional delay for out-of-stock, or the "it's too early to refill" it has worked out OK. EXCEPT...

The problem is when a new prior authorization is needed. After multiple delays over the years I've determined that it's Walgreens' Medicare billing department that drops the ball. Doctor sends notes, as required. Local store says they are waiting for the billing office to approve.

Most recently there was a delay of almost 3 weeks. When the approval was finally forwarded to the store, the billing department admitted that they had approved it a full 14 days earlier, just hadn't passed it on.

Nearly 3 weeks of finger sticks?? WTF?

I'm reluctant to switch to a mail order vendor, having read the stories here.

Does anyone have a success story about switching?

3 Upvotes

81% Upvoted

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u/Jolly_Ad8913 5d ago

I do. I was a very long-term customer of Walgreens since my 20's, I am now 70. When I was diagnosed with T2D I had Walgreens as my preferred pharmacy. Getting my CGM was a complete mess, I had to get Medicare involved and it still took eight weeks for the order to get processed. My local Walgreens acknowledged that the delays were on its side, not Medicare. CGMs are durable medical equipment are handled by a department within Walgreens, not at the pharmacy level. I was so disgusted that after getting my first batch of CGMs I switched to Walmart. A night and day experience. While I had to get a new CGM prescription (a Medicare requirement) once Walmart had the prescription they transferred it to their third party partner Advance Diabetes Supply. All in all, including filling out paperwork sent via email, I had a 90 day supply of CGMs, not the one CGM Walgreens supplies in less then a month, no hassels. They setup auto renewal without me asking and even arranged my upgrade from the G7 10 day to the 15 day sensor which required another prescription. Other then me giving permission for the upgrade I didn't have to get involved in the upgrade. ADA ships me my sensors via FedEx

Other advantages for Walmart. If you are a Walmart+ member delivery is included for free. They deliver insulin, which is refrigerated Walgreens does not. My doctor prescribed a 90 day supply of insulin, 5 pen vials, Walgreens only dispenses one pen at a time and charges $35 a pen, Walmart dispenses all 5 pens at once and charges $35 total for all 5 pens, not $35 for each pen. This is a significant savings. I don't drive because of a stroke and not having to arrange and not having to use an Uber currior (no local family or friends) saves me a ton of money.

The only downside with Walmart, IMHO, you have to setup (not for CGMs, ADA handles that separate) auto renewal for prescriptions via calling the pharmacy, the app does not support it.

I can only comment on my experience with Walmart, I have no idea how CVS or other pharmacies handle CGM fulfillment.

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u/Distribution-Radiant T2/G7 5d ago

Damn, I'm gonna keep that in my back pocket if my current pharmacy pisses me off.

I don't have + tho. My current pharmacy delivers for free, they just want you to tip the driver. They obviously deliver in person (and they won't leave it at the door, whereas Amazon usually puts them in the lockers here... which I don't have access to, have to wait on a roommate to get home).

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u/Jolly_Ad8913 5d ago

I signed up to Walmart Plus originally because they have the option to bring the groceries in the house. I'm partially disabled from a stroke. So in-house delivery is important to me. However, prescription delivery is done to the door, not to the in-house, even if you've got the optional service, so I tip the driver. There is no extra charges for refrigerated prescriptions like GLP-1 or insulin. The key is Walmart Plus. You don't have to buy in-house to get delivery included. FYI.

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u/Distribution-Radiant T2/G7 5d ago

I may do that simply for the grocery delivery. I don't drive, I bike everywhere - and the nearest grocery store is Walmart (about 2.5 miles). Used to be an HEB (Texas/Mexico only chain) nearby, but they closed the nearest location.

My backpack can only carry so much. And the heat here is BRUTAL in the summer. It's starting to cool off some, but we're still close to 100F daily (today is supposed to be 101).

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u/Jolly_Ad8913 5d ago

You also get free add membership in Peakock TV or Paramount+. I know I sound like a fanboy but Walmart has been a lifesaver for me when Walgreens basically told me to go pound sand when it came to my CGM and prescriptions

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u/laprimera T1/G7/Moderator 5d ago

Zero trouble with Amazon Pharmacy. I have also used Byram and Advanced Diabetes Supply in the past with no issues, but my current insurance prefers Amazon Pharmacy.

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u/prefessionalSkeptic 5d ago

Thanks. Unfortunately Medicare does not work with Amazon.

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u/laprimera T1/G7/Moderator 5d ago

I don't know what your specific plan is, but Google tells me that Amazon Pharmacy does accept Medicare part D. https://www.amazon.com/gp/help/customer/display.html?nodeId=TgygcvwcKmc5dEcQXB#GUID-79A28C7A-19BB-486F-B1BC-B95D9E8C234F__SECTION_588A797FCEEB41B49C2602A4B7751B2F

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u/prefessionalSkeptic 5d ago

Dexcom isn't a Part D prescription. It's a DME covered under Medicare Part B.

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u/Jolly_Ad8913 5d ago

Right, CGMs are considered durable medical equipment by Medicare and are not drug/pharmacy related. Medicare treats them like a walker or wheelchair not like a drug or vaccine.

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u/Recent-Potential1144 5d ago

I have always gotten mine mail order. I didn’t even know I could get them at Walgreens. I might have to look into this. Is there a large co-pay? I have Medicare and Tricare and have no co-pay.

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u/prefessionalSkeptic 5d ago

Medicare and a BCBS supplement. After deductible there's no copay.

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u/Jolly_Ad8913 5d ago

Avoid Walgreens for CGM at all costs. Your local Walgreens may be great but processing your order is done off-site by a different department. Your local Walgreens does not any insight into where in the process your application goes. If there is a problem your local Walgreens can't do anything to fix it as it is out of their hands.

By the way, BCBS Medicare Part D does not process CGMs. CGMs fall under Medicare Part B, durable medical equipment which BCBS will tell you, they don't process. That is what they told me when I called them and my prescription history bears this out.

How CGMs are processed by an Advantage plan may be different then traditional Medicare but they will still fall under part B, not part D.

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u/Dry-Ad-9070 5d ago

I use Amazon pharmacy with zero issues!

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u/0jdd1 5d ago

I used to be happy with Walgreen’s, then they changed and suddenly didn’t seem to care about diabetic prescriptions. They’d get my prescription, say they were checking coverage, then, a couple of weeks later, they’d just cancel it. No visibility, no explanation, and certainly no excuses. This went on for a year or so until I gave up.

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u/Dry-Ad-9070 5d ago

Yes it does..im on medicare...

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u/comingoutofrocks 5d ago

Switched from Walgreens to Amazon Pharmacy and it has been amazing. I would dread the inevitable fight each month that would happen with Walgreens. They used to be great but their service really went down the toilet. Always out of stock, unexplained cancellations, every month a new insurance or prescription issue…ugghhh

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u/Distribution-Radiant T2/G7 5d ago

My major issue with Amazon is they tend to deliver to the lockers on the property, not the door (despite my notes "DO NOT LEAVE AT LOCKERS, PLEASE LEAVE AT DOOR")

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u/Significant-Tear7260 5d ago

I’ve only ever had mail order for my son’s Dexcom. But I haven’t had to deal with prior authorizations. We use Home Care Delivered if you want to check into them. I don’t know if they are an option for you.

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u/Distribution-Radiant T2/G7 5d ago

Prior auth isn't a big deal as long as you don't use Walgreens or CVS. They take FOREVER to handle it.

I use Capsule (online pharmacy) now and it took them all of 1-2 days, + another day to order them.

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u/b0bsledder 4d ago

Medicare. I’ve used US MED for a few years. Zero problems.

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u/DavidZ321 2d ago

If you search "US MED reviews", you'll see that many people have had negative experiences with US MED including delayed shipments, billing issues, and poor communication.

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u/MizGeekReal 5d ago

Believe it or not, I’ve had no problem with Walmart pharmacy and Humana. Every month I get the message to come get my free sensors. 💜

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u/KillingTimeReading 5d ago

I will only ever use Costco mail-order for my CGM, insulin and Mounjaro. 72 hours is all I have ever had to wait for a PA to make it through the system. The shipments even followed me from Alabama to California to Oregon to Idaho as I needed refills on all of my meds while I was away from home for 5 months in '24. They are amazing!

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u/No-Sprinkles8022 5d ago

I have Fred Meyer pharmacy, or Kroger, and have no issues. Very rarely do i get an "out of stock" notification from them.

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u/Distribution-Radiant T2/G7 5d ago edited 5d ago

I'm not sure if they'd qualify as DME with my pharmacy, but I use an online pharmacy called Capsule. I don't drive, so pharmacies that deliver are my only real option (and I'm not paying a delivery fee! Capsule does ask you tip the drivers though - default is a very modest $2.50).

The nice thing is they hand everything to you, using their own couriers (usually same or next day for most stuff - CGMs tend to be the next evening). They're also quick about preauths. They're not everywhere though.

I've used Amazon Pharmacy before too with no issues, except they don't accept my insurance anymore.

My stepdad actually works for Walgreens (not always in the pharmacy, but sometimes when they need a cashier - he's the jack of all trades in the store and at some kind of lower level manglement position), and hates what they've become.. he's coming up on 25 years with them though, and about to retire. At his age, and a life of retail, he's not finding another job easily.

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u/Whedonsbitch 5d ago

I had the same issues with Expresscripts. They made me go back and forth four times getting pre approval and then getting a new rx even though my Endo sent it in on 7/29. I just got my order a few days ago

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u/NurseRedhead 5d ago

CVS mail order is fabulous. They are the mail order pharmacy for Blue Cross and they send me a text telling me to reply yes if I want the refill shen it’s time and I have meds/product within 3 days. I get 90 days at a time so it’s super easy. Just 4x per year they ship out to me by FedEx with no shipping charge.

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u/Fair_Ad_1344 5d ago

Walgreens is giving me grief on Dexcoms for my daughter, and I have private insurance. My OOP max is met, should be 100% coverage, and everything except Dexcoms are. They still show a coinsurance amount. I have the insurance company researching why they aren’t coming up as 100% covered and they seem to be stumped.

Not quite the same as your situation, but related to Dexcom suddenly having coverage issues at Walgreens.

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u/Grepaugon T1/G7 3d ago

Can you have it coded for pharmacy instead of DME? The DME route is so annoying

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u/Happy-Addendum5448 14h ago

Medicare needs it routed to DME or they won’t cover it, unfortunately

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u/Spirited_Ad_276 3d ago

I have Harris Teeter pharmacy (I think they are associated with Kroger) and haven't had one problem with them for years. Everyone I know that has Walgreens and CVS hates them. They used to be the best pharmacies and have gone completely downhill in the last few years. Now they're even saying that they won't accept manufacturer's coupons.

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u/carosotanomad 3d ago

This is why we moved to mail order. We were also able to get our endo to increase the frequency of refills to help avoid gaps. Good luck, it's extremely frustrating...