Dexcom & Omnipod Pricing…

I’m gonna try and kept this post as short as possible. This past November my Dr. prescribed me the Omnipod 5 & Dexcom G7. I was hesitant to try them because I knew both of those products were expensive and I didn’t think my insurance would cover enough for me to afford them. I get my Blue Cross Blue Shield insurance through my employment at Walmart. The Dr. told me he would send in the prescription just so I could see what the prices were. Surprisingly, both were COMPLETELY covered! Well now fast forward to the beginning of this year and I ordered a refill. Now the Dexcom are $100 and Omnipod are $150. At first I thought it was because I changed my plan during annual benefits enrollment last year. However I upgraded and went with the most expensive plan expecting that both of these products would still be covered.

So I called my insurance and asked them what was going on. According to the rep, she said I needed to max out my Out of Pocket (which is around $6700!!!!) before the products are completely covered. Which makes no sense because I didn’t reach the max last year and yet the prescriptions were covered. I tried explaining that to her but all she did was repeat the same thing she said earlier.

I managed to get a co-pay card for the Omnipod which brought them down to $50. And I applied for financial assistance for both Omnipod and Dexcom last night to see if that would be any better. Fingers Crossed

My questions is how were these prescriptions completely covered last year without reaching my max OOP?

EDIT: Age: 33 State: NC Pre-Tax Gross: $35000

submitted by /u/jasonpatrick72
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