After dealing with Edgepark for an entire year, I was able to get sensor refills from my Express Scripts, the online pharmacy used by my work health insurance. I believe I had to go to Edgepark in the first place because my Medicare coverage only includes Part A and Part B. My endocrinologist likely sent the original order to Edgepark since Medicare Part B does cover medical devices, just not drug prescriptions. Anyway, I had to pay a large copay on my first order, and subsequent orders would also require sizeable copays.
Since I also needed insulin and glucose test strips (backup) refills, my endocrinologist sent everything to Express Scripts, including the sensor kit refill. Since my work insurance covers prescriptions, the kits were covered 100%. In addition, several other items that used to have $60 copays were 100% covered.
Only the long-lasting insulin refill had a $60 copay. I checked the invoice for this order and here is what my work paid:
- Freestyle Libre 2 Sensor Kit (6 qty): $346.77
- One Touch Verio Strips 100’s (3 qty): $207.36
- Toujeo Solostar Pen 1.5ml 3s (3 qty): $1,102.44
- Humalog Kwkpn 3ml 5’s (4 qty): $1,909.44
That is over $3,500 for just insulin and glucose testing for three months. For an entire year, this is over $14k and I have not included my other medications. I think I will have to move to Canada after I retire, at least until I qualify for Medicare again.
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Hmm, maybe Medicare coverage rules have changed recently?
If type 2 diabetes was not covered before, how was I getting the first two orders partially paid for? Was I being classified as a post-transplant patient instead?
Life with chronic diseases 