6/4/2019
Insurance Coverage:
What To Ask Your Insurance Company If You Have Diabetes

The Berrie Center recommends that all patients review the details of their insurance coverage of their diabetes medications, supplies and devices on a regular basis. Each plan is different and the Berrie Center is not familiar with the details of each plan’s coverage.
Your insurance plan may only cover certain brands of medications, only one choice in a class of medication, and only certain brands of devices and supplies. In some cases, the insurance company may require additional steps from the MD and Berrie Center - including processing a prior authorization (PAs), an appeal, or a peer-to-peer review – prior to approval. Coverage denials remain possible as well.

Importantly, the insurance plan may not provide any coverage for a specific diabetes medication, supply or device under any circumstance. You should become familiar with these features of your insurance plan. Patients who choose to use an option that is not covered by their insurance plan choose to pay out of pocket. Finally, these insurance coverage decisions change periodically.

As described below, we recommend that patients and families call their insurance company (at the 800 number on the back of the insurance card) and ask the questions below. It is also important to identify all the entities who participate in approving and providing your medications, supplies and devices.

1. Insurance plan coverage of medications
Learn about which medications are covered under your plan:
a. What diabetes medications are covered in your insurance’s formulary? Which are not?
b. Where or how should you obtain medication (i.e. retail pharmacy or mail order)?
c. What is your co-pay for retail pharmacy and for mail order pharmacy purchases?

2. Insurance plan coverage of supplies
Call the insurance plan and ask how supplies such as glucose meters and test strips are covered:
a. What meters and strips are covered in your formulary? Which are not?
b. Where or how should you obtain medication (i.e. retail pharmacy or mail order)?
c. What is your co-pay for retail pharmacy and for mail order pharmacy purchases?

3. Insurance plan coverage of pumps and sensors
Call your insurance plan and ask:
a. What pumps and sensors does your plan cover?
b. Who will provide my equipment under the terms of your insurance? Is your insurance plan contracted with a second company, a Durable Medical Equipment (DME) Provider to provide my pump or sensor? Is my DME provided instead by the pharmacy benefits component of my insurance plan?
c. If medical equipment to be provided by a DME provider, call the DME provider to set up an account