Heads are shaking over the big news that Walgreens is being fined $269 Million (!) on claims that it fraudulently over-billed Medicare and Medicaid for insulin pens, tampering with written prescriptions in order to bill for full boxes rather than individual pens. With instances like these surfacing, it's tough to stay positive about the potential good that pharmacies can do.

One way they can provide positive value to the Diabetes Community is to potentially revolutionize access to CGMs for PWDs (people with diabetes) across the nation.

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That is, the supplies for these powerful systems are finally making their way into local pharmacies -- increasing accessibility, and hopefully affordability too.

For example, the newest Dexcom model G6 receivers, transmitters and sensors are now available for purchase at Costco Pharmacies for the bulk chain's member customers at a lower cost than anywhere else.

This is a priority for Dexcom, company officials note, and it will be fascinating to see how local pharmacies impact the broader CGM access conversation as we move forward in 2019 and beyond.

 

CGM in Pharmacies: Then and Now

The effort to make CGM supplies more readily available for retail purchase began back in 2015, when a half-dozen or more insurance plans began covering CGM supplies categorized as a "pharmacy benefit" rather than the traditional classification as "Durable Medical Equipment (DME)." This meant people with certain plans would no longer be bound to buying supplies from designated third-party medical equipment suppliers or directly from the manufacturer, but rather could purchase them wherever medications are sold. Anthem and UnitedHealthcare (UHC) were among the big insurance carriers taking that important first step toward eventual access to over-the-counter purchase of CGM supplies in local pharmacy chains like CVS or Walgreens.

Dexcom's stated goal at the time was to process about 70% of its CGM business through mail order and retail pharmacies, including "drop shipments" of orders prepared for pickup 24 hours in advance. Presumably, that "just in time" shipping policy was meant to avoid pharmacies stockpiling expired sensors that they can't sell, or running out of supplies.

Remember, at the time, the G4 was still the most-current tech on the market because the G5 hadn't yet been approved.

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In the years since, this initiative to go big on pharmacy sales basically fizzled, while Dexcom was busy launching its latest G5 and G6 models, expanding its data-sharing capabilities, concentrating on obtaining the "no calibrations" designation from FDA (eliminating the need for fingerstick checks to assure accuracy), and also developing its relationship with Verily to build a small, low-cost CGM for the future.

Dexcom realized that the G5 wasn't the platform to expand pharmacy accessibility as it had planned, and that the later G6 model would be the best one to eventually make that happen. Now, four years down the road, with the G6 platform in place, Dexcom is focusing its efforts on pharmacy access once again.

By the end of 2019, Dexcom hopes to increase its CGM business going through pharmacy channels -- as much as 70% of their sensor business, to be exact. Per the company's talking points, pharmacy distribution allows for "a more seamless experience for physicians and patients, changing the once eight-step, month-long distribution process into four simple steps that enable a patient to get their Dexcom device in as few as one or two days through their pharmacist."

 

50% More Doctors Prescribing Dexcom?

Currently, most CGM users are still purchasing their supplies from designated third-party medical equipment vendors or directly from the manufacturer. And overall use of CGM among the PWD population remains low, for a number of reasons including provider reluctance to prescribe the systems, and of course, cost.

Even with some insurers now classifying CGM as a pharmacy benefit, it remains a "Your Insurance Coverage May Vary" situation in terms of how much any individual might pay for supplies -- some plans require only a low, fixed co-pay applied to all pharmacy benefit items, while others require co-insurance, where you pay a percentage of the actual cost of the item. Still other plans require that you meet an annual deductible before any co-pay or co-insurance kicks in. It all varies.

Interestingly, in its most recent investor update, Dexcom expressed belief that more than 50% of healthcare professionals would increase the number of prescriptions they write for CGM if it were available across the board as a mainstream pharmacy benefit to all patients -- that's incredible. Dexcom also noted that 49% of doctors say all the insurance red tape currently impacts their willingness to prescribe CGM. 

What they are essentially saying is that making CGM supplies cheaper and more readily available could be the key to helping CGM become a true standard of care.

From the patient affordability POV, check out pricing for Dexcom at Costco pharmacies versus traditional costs:

To get the Costco pricing, you of course need to be a Costco member ($60) and also sign up for their free pharmacy program. From there, Dexcom confirms that the cost savings are enormous:

  • G6 Transmitter: $28.88 each (versus $237 each if purchased directly from Dexcom!)
  • G6 Receiver: $35.96 each (versus $365 cost from Dexcom)
  • Box of G6 sensors (three pack): $318.10 (versus $349 from Dexcom)

Dexcom notes that for a new customer, this is a start-up savings of roughly $870 versus its traditional pricing!

** UPDATE: As of April 1, 2019, the Costco Pharmacy membership prices have gone up according to the latest company infomation published online:

  • G6: Transmitter: $145.51 each
  • G6 Receiver: $218.27 each
  • Box of G6 Sensors (three pack): $318.10

These Costco prices are self-pay only, as insurance isn't applicable there (also not Medicare or Medicaid). So for anyone who may have a lower insurance co-pay or deductible requirement, they may be better off sticking with their traditional purchase channels.

Unfortunately, lots of patients and even many Costco pharmacy folk are unaware of this savings program, so if asked they quote much higher prices, up to $1,100 for a single box of sensors -- ugh! We're also hearing that over time, some Costco pharmacists are insisting that they must check insurance and that this G6 discount only applies if you've already been denied insurance coverage. That's not everywhere and it's not sure if that's even allowed, but it's still a barrier to this discount program.

Clearly, those hurdles need to be overcome. But in any case, it's a great step forward in expanding CGM access.

No doubt, as the Dexcom-Verily project to create a consumer-friendly mini-CGM moves forward (anticipated by the end of 2020), we certainly see more big pharmacy chains adding CGM tech to their shelves.

As of now, Dexcom's the only functional CGM that is available in the pharmacy and it doesn't appear the other ones -- Medtronic and Eversense, at the moment -- are moving in that direction. It's important to note that while it's not (yet) an actual CGM with real-time glucose alerts, the Abbott Freestyle Libre Flash Glucose Monitoring (FGM) system has been available primarily through pharmacies like CVS, Kroger, Walgreens, and Rite Aid since it launched in late 2017.

Really, it's only a matter of time before all the CGM tech gets on the same page and is available within these pharmacy channels, creating broader and (hopefully) better access and affordability for those of us with diabetes.