Audience: Providers of impacted patients
Continuous Glucose Monitoring Systems (CGMS) are a medical benefit that previously required a Durable Medical Equipment (DME) provider for processing. We are notifying you that we have made recent changes that now allow certain CGMS products to process at a retail pharmacy.
Freestyle Libre and Dexcom G6 CGMS products will now be available at retail pharmacies. Patients may continue to choose to receive them through a DME provider if desired. This change applies to Commercial, Exchange, and Medicare Advantage members only.
CGMS products will remain a medical benefit, and any required prior authorization needed for these products will still apply. For our Commercial and Exchange members, if the products are being submitted by a pharmacy, the Excellus BlueCross BlueShield pharmacy system will use smart logic to determine appropriate age and a history of insulin use. If both criteria are satisfied, a prior authorization is not needed as the claim will pay automatically. For Medicare Advantage members, a prior authorization submission is still required.
Expanding CGMS access to retail pharmacies can help provide greater convenience, patient satisfaction, and improved testing adherence particularly for members already using a retail pharmacy for accessing multiple medications to manage their diabetes.
One or more of your patients has been identified as a potential candidate for transitioning their current CGMS products to a retail pharmacy. Those patients are listed in the chart at the end of this notice.
Thank you for the quality of care and service that you provide to our members, your patients.