Currentblue cross blue shield - michiganPolicy N/A

provider_alert_cgm_coverage

Notifies Blue Cross Blue Shield of Michigan and Blue Care Network commercial members and providers that certain CGM products may be obtained through participating network pharmacies (pharmacy benefit) with potentially lower out-of-pocket cost; medical-benefit DME option remains available without penalty. Applies only to Blue Cross and BCN commercial members, not Medicare Advantage.

Policy Summary

Payerblue cross blue shield - michigan

Policyprovider_alert_cgm_coverage

Policy CodePolicy N/A

Change TypeCoverage clarification / addition

Effective Date

Next Review Date

Key ActionWhen prescribing CGM products to be filled through pharmacy benefits, providers should be prepared to obtain prior authorization if required by the member's plan.

SourceLink

POLICY UPDATE CHANGES

Certain CGM products are available through participating network pharmacies for Blue Cross and BCN commercial members, potentially lowering out-of-pocket costs.

Clarified that the information applies only to Blue Cross and BCN commercial members and not to Medicare Advantage members.

5CGM product lines listed

2Benefit pathways (pharmacy or medical/DME)

What is changing

Selected continuous glucose monitoring (CGM) product families — Dexcom G6 (readers, transmitters and sensors), Dexcom G7 (readers and sensors), FreeStyle Libre 14-day, FreeStyle Libre 2, and FreeStyle Libre 3 (readers and sensors) — are now available to be dispensed via participating network pharmacies for Blue Cross and BCN commercial members. Members must have pharmacy benefit coverage to obtain these CGM products at a retail pharmacy, and filling through a participating pharmacy may result in a lower out-of-pocket cost compared with obtaining the products through the medical/DME benefit.