My followers may recall that I've written not-so-kind blog posts about how Dexcom is paying legally-exempted rebate kickbacks (see https://blog.sstrumello.com/2023/06/dexcom-pays-pbms-kickbacks-to-exclude.html for one such blog post) to major Pharmacy Benefit Managers (PBMs) contingent upon "formulary exclusions" of less costly rival continuous glucose monitoring (CGM) systems such as Abbott Freestyle Libre.
The retail prices for both CGM sensor brands are remarkably close (ranging from $57.33/sensor to $61.28/sensor). However, the cost computation is not based on the cost per sensor, but must be computed on a cost per day of each sensor being worn. Abbott Libre 3 sensors can be worn for 14 days, whereas Dexcom sensors can be worn for only 10 days. (More frequent sensor replacement costs patients more money unless their insurance picks up some portion of the cost; some such as my plan now pick up about 37% of the cost to keep the rebate cash flowing to Caremark). Anyway, using the per sensor CGM costs derived from Costco's Member Prescription Program https://www.costco.com/cmpp this summer, then I computed a cost per day of wearing CGM sensors (if you are paying cash) which is as follows:
- Dexcom G6 Sensors $6.13 per day of usage
- Dexcom G7 Sensors $5.73 per day of usage
- Abbott Freestyle Libre 3 Sensors $4.23 per day of usage
Now, as noted, earlier in 2023, my own insurance company (Aetna) PBM Caremark started covering about 37% of the cost of my CGM purchases pre-deductible which they did not do the previous year, which means my cost per day is $3.88. I recall thinking: "OK, that's even better for me!" and I did not think anything of it at the time. But then it occurred to me: they want to keep the rebate kickbacks flowing to them, and they know that if patients now have other options, they would do the math (as I did) and might choose the (35.5%) less costly rival CGM but they'd get zero rebates in that case. As I told the FTC in my letter to them, the CVS Health/Aetna/Caremark decision to cover part of the cost of the CGM sensors was executed with near-surgical precision.
Specifically, Dexcom is paying what are effectively bribes (kickbacks) to Aetna/CVS Caremark and United Healthcare's OptumRx to keep less costly CGMs "off-formulary". I documented Caremark's published list of formulary exclusions at https://www.caremark.com/portal/asset/Formulary_Exclusion_Drug_List.pdf -- see page 9 of 21 for the language of exclusion, as well as to United Healthcare/OptumRx (see that company's "standard" formulary exclusion list at https://professionals.optumrx.com/content/dam/optum3/professional-optumrx/resources/pdfs/Premium_Standard_Abridged_PDF_13188_v98_09072022.pdf and its "premium" formulary exclusion list at https://hr.nd.edu/assets/491518/jan_2023_b2b_cycle_premium_formulary_exclusion_list.pdf for the nitty-gritty details).
We know with absolute certainty these kickbacks are happening.
For its part, Dexcom is aware that its migration to the pharmacy (as opposed to the DME or Durable Medical Equipment) distribution channel causes its product prices to be artificially inflated. As a result, Dexcom now offers manufacturer discount coupons which are conveniently distributed via GoodRx and on the manufacturer's own website enabling patients to "Save $200 per 30-day supply of sensors and an additional $200 on each 3-month transmitter" which are available at https://www.dexcom.com/en-us/savings-center-cgm-without-insurance/. As far as I can tell, these coupons also have no expiration dates, they are part of Dexcom's ongoing marketing expenses - they are not "limited-time" offers.
My readers may recall that I had the luxury of "test driving" the new Abbott Freestyle Libre 3 CGM for six weeks. I extended that for another 2 weeks with a sample which Abbott gives to anyone. I wrote about my "test drive" at https://blog.sstrumello.com/2022/12/my-trial-of-new-abbott-freestyle-libre-3.html. However, while Dexcom dominates what Automated Insulin Delivery (AID) systems are on the market currently, its newest product (the G7 model) is not universally loved; in fact, it gets very mixed reviews such as people loving the half-hour warm-up time, but really disliking other aspects of the new Dexcom, such as repeated signal losses several times a day and not-at-all-accurate first day numbers (see https://diabetesstories.com/2023/07/21/im-sorry-to-say-im-not-loving-dexcoms-g7/ for one such review).
However, because I'm not on Medicare as my friend Riva Greenberg is, and also because Dexcom pays my insurance PBM Caremark kickbacks to prevent me from having access to non-Dexcom CGMs, I was unaware of any program offered by Abbott for Freestyle Libre until I read an interview with Abbott Diabetes Care CMO Mahmood Kazemi in MedTechDive (see the article at https://www.medtechdive.com/news/abbott-diabetes-mahmood-kazemi-cgm-access/700015/ for the article) and in that interview, the following Q&A came up:
Q: What about cash-pay programs?
A: We do have a program for the U.S. where if someone is not able to get coverage for that through their commercial insurance, or if they just have no insurance at all, and they need to pay cash, no one has to pay more than $75 per month for their two sensors (note that the Costco Pharmacy price for a box of 2 Libre 3 sensors was $118.51).
The latter part of the Abbott coupon on Libre was news to me, and I consider myself pretty well-informed on these matters. If I wasn't aware of it, I likely would have completely missed the following language on Abbott's web page for Freestyle Libre (see https://www.freestyle.abbott/us-en/private-insurance.html for more) under the tab for "Cost & Coverage", it says:
Under the section entitled "How much will it cost?", Abbott says "If you are commercially insured and asked to pay over $75 for two sensors, please contact our customer care team to get an eSavings voucher and start saving immediately on your sensors. You may also contact our customer care team if you have any additional cost and coverage questions."
Abbott's Customer Care Team can be reached by telephone at 1-855-632-8658 (Available Monday to Friday from 8AM - 8PM ET). You must call, provide them with some basic information, and ask them for the eSavings voucher so you can get two Libre sensors for no more than $75. That applies to anyone with or without insurance.
So, I called Abbott customer care team and asked them to send me an eSavings voucher. Voila: about 24 hours later and I had a coupon to buy Libre sensors for $37.50 each compared to $61.28 for Dexcom G6. The cost per day of wearing a Libre 3 sensor with the new, manufacturer coupon is $2.68 (compared to $3.88 if I used my insurance pre-deductible)! As for "upgrading" to G7; on that, I plan to wait until Dexcom stops selling the G6. But with a coupon from Abbott for Libre 3, I am no longer forced to use Dexcom.
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It's nice to have options, and not be FORCED by a rebate-collecting PBM based on whomever pays them the most in rebate kickbacks. With Abbott's eSavings voucher for Freestyle Libre, that could be an option which did not exist before the Abbott manufacturer coupon emerged.
Author P.S., December 19, 2023: Abbott has informed me that its eSavings vouchers expire at the end of each calendar year. They informed me patients will therefore need to call the toll-free telephone number and request a new voucher in January for a new coupon which expires a year later. Just beware on the timing and expiration date of the eSavings voucher you may receive.
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