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Change to therapeutic continuous glucose monitor benefit

Key points for prescribing providers:
  • This change applies to members on commercial plans only, not Medicare or Medicaid.
  • Affected members have been notified by mail and directed to contact their provider for a new prescription.
  • If members have a prior authorization through DME, they will not need to go through that process for six months. 
  • Going forward, please write CGM prescriptions to pharmacy benefits, not DME.
Covered CGM supplies

Freestyle Libre 2: Sensor, Reader
Freestyle Libre 3: System
Freestyle Libre: 14-Day & 10-Day Sensor, Reader
Dexcom G6: Sensor, Transmitter, Receiver
Dexcom G7: Sensor, Transmitter, Receiver

Questions? 

Our Customer Service team is available by phone from 7:00 a.m. to 5:00 p.m. (Pacific time), Monday through Friday at 888-977-9299, TTY: 711. (We accept all relay calls.) Or reach us by email at CS@PacificSource.com.