As much excitement as there is about continuous glucose monitoring (CGM) technology becoming the new standard of care for diabetes, the reality is that it’s still too expensive for many people to afford.
Despite the proven benefits of CGM, and the fact that it’s becoming more accessible for some people with type 1 diabetes (T1D) and good health insurance, it remains a luxury for many.
And that’s before even looking at the factors of race, socioeconomics, and different types of diabetes, which tend to lower diabetes technology usage dramatically.
“It’s a helpful tool, but too expensive for most people to maintain even with insurance,” says Mike Durbin in Indiana, who gave up his Dexcom G6 CGM in 2020 at the start of the COVID-19 pandemic because of cost.
He’s not alone, by a long shot.
Of the three traditional CGM devices currently on the market in the United States — Dexcom G6, the Medtronic Minimed Guardian Connect, and the Abbott FreeStyle Libre 2 — many find the Abbott Libre to be the most affordable. It’s a bit different from the others in that you wear it on your upper arm rather than your abdomen, and it doesn’t require a separate transmitter attached to each new sensor, which helps lower costs.
Keep in mind that a CGM requires a prescription, so you’ll have to work with a healthcare professional to apply for one.
Once approved, you can buy the system and supplies for some CGMs directly from the manufacturer or a third-party medical equipment supplier like Edgepark, and some are also now available in U.S. retail pharmacies like Walgreens and Rite Aid.
Of course, health insurance may ease the financial burden, but it’s difficult to assess just how much because health plans and approved benefits vary greatly. High deductible and coinsurance plans require people to put down large amounts of money before their coverage kicks in.
So be sure to check with your insurance plan first to determine what coverage you may have for obtaining a CGM system, and what it may cost to get the supplies you need over time.
Keep in mind, too, that sometimes insurers deny coverage at first and it may require you to self-advocate — along with your healthcare professional — to demonstrate your “medical necessity” for getting a CGM.
Below are the basics on pricing.
(This does not include any peripheral supplies you may need, such as alcohol and adhesive wipes, or medical tape to help keep sensors attached.)
Until spring 2021, Dexcom sold their systems and supplies directly via their website, but they switched to working with Edgepark for online ordering.
You can also purchase Dexcom G6 supplies in large retail pharmacies across the United States, including CVS, Rite Aid, and Walgreens. Cash prices vary, but most locations we queried say that the price for a Dexcom G6 transmitter is just under $300, while a 3-pack box of G6 sensors runs roughly $400.
Rough retail costs per year without any insurance factored in:
- a total of $1,200 for Dexcom G6 transmitters (each lasts 90 days, so 4 transmitters per year)
- a total of $4,800 for a box of 3 Dexcom G6 sensors (each sensor lasts 10 days)
- estimated total: $6,000 per year, or $500 a month
Dexcom G6 supplies are also available at Costco, with discount prices for members who also sign up for their free pharmacy program. Store membership costs $60 per year.
As of April 2021, the Costco Pharmacy membership cash prices are as follows based on the latest company info online:
- a Dexcom G6 transmitter: $277.62 each (or membership discount price: $132.24)
- a box of Dexcom G6 sensors (3-pack): $384.60 (or $303.74 membership discount price)
- a Dexcom G6 receiver: $417.92 each (or $203.29 membership discount price)
- estimated total: $4,173 per year for lowest Costco membership, or $347 per month (not counting the optional Dexcom G6 receiver)
Many think that the Medtronic Minimed Guardian Connect CGM is only integrated into the company’s Minimed insulin pumps, but there is also a stand-alone CGM available. The Medtronic Minimed CGM requires a separate seashell-shaped transmitter that connects to each sensor that is worn for 7 days.
Medtronic doesn’t sell its CGM sensors and supplies at pharmacies, but you can find these at mail-order distribution companies and directly through Medtronic’s online store.
- a transmitter (with a 12-month warranty): $620
- Medtronic Minimed Guardian Connect CGM sensors (5-pack, each approved for 7-day wear): $345
- estimated total: $4,208 per year, or $351 per month
The Abbott FreeStyle Libre Flash Glucose Monitoring (FGM) system is growing in popularity, especially now that the latest Abbott FreeStyle Libre 2 model offers optional real-time alerts that can notify users about high and low glucose levels.
As of mid-2021, the Abbott FreeStyle Libre 2 still requires a separate hand-held reader to scan the circular sensor you wear on your upper arm for up to 14 days.
Abbott FreeStyle Libre 2 launched in late 2017 and is available through national pharmacies like Costco, CVS, Kroger, Walgreens, and Rite Aid. Abbott tells DiabetesMine that most Abbott FreeStyle Libre 2 users in the United States are getting their sensors through retail pharmacies.
Notably, Abbott says the FreeStyle Libre 2 costs 70 percent less than the list price of other CGM systems currently available — in part because it doesn’t require a separate transmitter with each sensor like the competing products do.
Here are the approximate prices for the Abbott FreeStyle Libre 2 system in pharmacies:
- sensors: list price of $54 per 14-day sensor, according to Abbott — generally $58 to $69 at retail pharmacies like Costco and Walgreens
- with commercial insurance, most people pay between $10 and $75 per month for the Abbott Libre 14-day sensors at participating pharmacies
- hand-held reader: $70
- total: $1582 to $1868 for a year’s worth, or approximately $160 per month
Additionally, there is the Eversense implantable CGM from Senseonics that lasts for 3 months. A simple surgical procedure in a doctor’s office implants it underneath your skin. It is controlled by a smart phone app that offers high and low blood glucose level alarms, and data review.
This newer system is gaining traction and is not yet available everywhere. But according to the company, it’s covered by Aetna, Cigna, Humana, and BCBS of Illinois. Medicare announced coverage starting in 2020, but after a lapse due to the COVID-19 pandemic, new customers will have to wait until Senseonics opens up the program again.
The company initially offered a $99 start price, but that was discontinued in 2020 due to the impact of the COVID-19 pandemic. Also, that didn’t include the doctor’s office visits necessary to insert and remove implanted sensors. A healthcare professional usually determines those costs. They typically run between $200 to $300 for insertion and $300 to $400 for removal and reinsertion.
estimated total: $6,400 per year, or $533 a month.
For Durbin in Indiana, the COVID-19 pandemic in early 2020 was what forced him to stop using a CGM.
Diagnosed with type 2 diabetes in 2008, Durbin later learned that he lives with a version of T1D known as latent autoimmune diabetes in adults (LADA). He used the Dexcom G6 for a few years, but after losing income due to the COVID-19 pandemic, it became unaffordable to him.
His $1,000 insurance deductible meant he had to pay a higher amount earlier in the year, so in February 2019 his first CGM order cost $1,237 for one box of Dexcom G6 sensors and the transmitter.
His insurance only allowed one box of sensors at a time. This was problematic because often a box didn’t last a full month as it’s supposed to. Each sensor has a 10-day wear label, but they often fail early. This means either going without CGM briefly or ordering additional sensors just in case.
Overall for Durbin, the math added up to nearly $3,000 for a year’s worth of CGM use, even with insurance coverage. And that was on top of the costs of insulin, other medications, doctor’s appointments and beyond.
“That’s just one expense,” he says about the CGM cost. “And when you have copays for a dozen different medications as well, it’s just too much.”
Travis Trombley in Michigan was one of many longtime T1Ds who heard about CGM technology for many years, but couldn’t afford it personally. Diagnosed at just 15 months old in the early 1980s, Trombley says his entire life is a story of “lack of health insurance” — even when he worked at a small community health clinic that provided insurance, but didn’t cover insulin and left him footing the bill.
Roughly a decade ago, uninsured but making too much for state Medicaid as an unmarried single male, Trombley says he experienced a downward spiral in his diabetes health and began experiencing eye complications.
He resorted to older human insulin — Humulin R and N — that was much less expensive but unreliable. Eventually, he started using Medicare but still couldn’t get a CGM because the federal program didn’t cover that diabetes technology at the time. Trombley considered buying a CGM internationally and having supplies sent to the United States. But Medicare eventually covered CGMs.
Now, he can finally afford the Abbott Libre, which he credits to lower interest rates, a refinancing, federal stimulus money, and expanded employment opportunities due to working from home.
“I recently got the Abbott Libre after wanting, wishing, and trying to raise my income enough to comfortably afford one and cover the copays of my insulin at the same time,” he tells DiabetesMine.
“I love it. I wish I could have entered the world of CGM use much sooner. Just in the first 3 weeks, I’m seeing far better glucose control.”
In Pennsylvania, T1D Sarah Kangas tells DiabetesMine that she can afford CGM with her employer insurance, and would give up pretty much anything else to keep her CGM if necessary.
“I gave up cable to make sure I had the funds available. Take away my washing machine, computer, microwave or dishwasher but leave my Dexcom G6!” she says.
She’s used the Dexcom G6 for 12 years now. The technology allows her to work and drive safely. Her life wouldn’t be the same without it. She pays roughly $190 for 3 months of supplies and the $80 for the CGM transmitter every 90 days. To her, that’s “the best money I spend.”
“From the healthcare professional’s perspective, CGM is often a cost burden and inaccessible for people who are underinsured, have lapses in health plans or new deductibles, or can’t get CGM covered due to not yet meeting insurance requirements,” says diabetes care and education specialist (DCES) Julia Blanchette in Ohio.
It’s more accessible now, though.
Blanchette says commercial insurers have loosened requirements, such as the 60 to 90 days of blood sugar logs they once mandated to approve a CGM. She says Medicaid in her state of Ohio eliminated any logbook requirement. But Medicaid still only covers CGM for people requiring insulin, taking at least 3 injections per day, or using insulin pump therapy.
Blanchette, who also lives with T1D, says she faces CGM affordability struggles herself too. That helps inform how she talks with people about this technology.
“I struggled to pay for very costly CGMs over the past few years. I maxed out my flex spending and found other ways to pay for the high cost, like charging my credit card until I could pay,” she says.
“CGM is trying to move towards the pharmacy model, which will save people a lot on monthly payments. For people with high costs through durable medical equipment (DME) suppliers, I encourage them to look into changing over to the pharmacy. This is successful and much cheaper in some cases but definitely not in all situations.”
In the state of Washington, another DCES Alison Evert works in primary care, and only sees a few PWDs throughout their 17 primary care clinics. But she’s quite familiar with CGM. She worked for years with the esteemed diabetes tech researcher Dr. Irl Hirsch from the University of Washington Medicine, who lives with T1D himself.
When Evert talks with her patients, she says it’s important to balance expectations of what CGM tech can offer with how realistic it is for that person to use and access it. Most of her patients use the Abbott Libre because it’s less expensive and offers a simpler version of continuous glucose monitoring compared to the Dexcom G6.
Often, some healthcare professionals aren’t as familiar with CGM technology. They’re less able to explain to their patients what exactly a system offers. This can lead to unrealistic expectations, especially if they don’t share details up front on pricing or the nuances of obtaining insurance coverage.
Evert’s clinic is just starting a pilot program to raise more awareness about CGM technology. That’s particularly important as companies like Dexcom and Abbott release more direct-to-consumer marketing and TV commercials promoting their tech, which leads more people to ask about it, she says.
“There’s a steep learning curve, and we struggle with assisting healthcare professionals to talk with their patients about CGM,” Evert says. “A lot of people decide they want to have it, regardless of talking about the cost and whether it’s covered.
“It starts with setting realistic expectations,” she says. “We want healthcare professionals to have the education to talk about this and set realistic expectations up front. This is better than having someone be all excited about CGM and then later be super-frustrated that they hadn’t heard it’s not and they can’t afford it out-of-pocket.”
Part of their initiative is creating bullet point messaging and one-page FAQs that both patients and healthcare professionals can use to address these key concerns during an appointment. The info includes cost and insurance coverage basics to help if a patient wants to push forward to get on a CGM.
“What we find in primary care, is that often we build a foundation for the healthcare professionals to know about and engage with CGM,” she says. “People are so excited about this technology, and we want it to be accessible to them as much as possible.”
Thankfully, each of the CGM device companies offer some official assistance to qualifying customers.
- Medtronic’s CGM Discount Access Program can lower costs to as little as $75 per month for people meeting certain criteria. Call to verify your eligibility: 1-800-646-4633.
- Dexcom offers a Patient Assistance Program to current U.S. customers who lost their health insurance coverage as a result of the COVID-19 pandemic. You’ll need to submit an application to determine eligibility. See more details at their FAQ page.
- Abbott offers the MyFreeStyle program for people who might want to try the Abbott Libre system before buying it. People who meet the eligibility requirements can get a voucher for a free 14-day sensor and reader for $0 copay. Sign up here to learn more.
- Senseonics tells us that a new patient assistance program for the Eversense CGM will be operational soon under the company’s new collaboration with Ascensia Diabetes Care. To apply or learn more call: 844-736-7348.
Buy at the pharmacy. Both Abbott Libre and Dexcom G6 supplies are available in pharmacies. This can help you avoid a higher deductible through traditional “DME” coverage. But some insurance plans don’t allow for pharmacy coverage with CGM. It may also require an appeal or doctor-initiated push to convince a plan to allow this. Check with your insurance and doctor.
Consider a loaner “Professional CGM.” Rather than buying your own personal CGM to use at home, some clinics offer a “professional” CGM that you can wear for short periods of time to get a snapshot of your glucose data and diabetes management. These loaner units may be “blinded,” so that only the doctor can initially see the data to review with you afterward. People generally do not receive charges for these beyond the cost of their doctor’s visits.
Seek out samples. While it’s less common, some doctor’s offices and clinics have a stock of extra supplies they keep on hand that they may be willing to share with you. This won’t provide a reliable or steady flow of CGM supplies, but it might be something to consider for a start.
Appeal to the patient community. People in the community do a lot to help each other out, from sharing surplus supplies to grassroots fundraising. One effort known as Mutual Aid Diabetes (MAD) frequently uses social media to amplify calls for assistance and steer people to aid programs. Also, some nonprofit organizations offer grants to families in need, such as Will’s Way, created by an Indiana D-Mom and her son Will with T1D. Kyler Cares out of New York also helps families in need to afford insulin pumps and CGM supplies.
Try restarting sensors. While it’s not an FDA-approved tactic, many CGM users turn to the DIY tactic of hacking their devices to prolong their lifecycles, thereby saving money. It’s not as simple as pushing a button, but some DIYers have discovered how they can restart Dexcom G6 sensors to use beyond 10 days and transmitters past the 90-day mark. DIYers also found that they can extend the life of Abbott Libre sensors. This comes with a cautionary warning of “do it at your own risk,” but it’s a common search and discussion topic in online forums when discussing the costs of CGM use.