u/Illustrious_Mud_3407

I’m genuinely confused and wondering if anyone else has dealt with this.

I’ve been using a CGM (Dexcom G7) for a while now and it was covered before with no issues. Same insurance, same prescription, same doctor.

Now suddenly:

• the pharmacy says it’s not covered
• insurance says it needs prior authorization
• another rep told me it has to go through DME instead of pharmacy benefits
• and the supplier quoted me almost $900 out of pocket

I’ve spent hours calling insurance, the pharmacy, and suppliers and I still don’t understand what actually changed.

Has anyone else dealt with this before? Did your insurance randomly switch CGMs from pharmacy coverage to DME? Or is this maybe a deductible issue?

Honestly managing diabetes is already exhausting enough without having to become an insurance expert too.