Walgreens and CGMs: Providers emphasize billing, service expertise

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Friday, November 22, 2019

DEERFIELD, Ill. – Walgreens has made a push into the continuous glucose monitoring market, but HME providers warn that providing diabetes care is a different animal than filling prescriptions.

The onerous paperwork, alone, would seem to be a huge obstacle for retail pharmacies, says Tim Cady, president of Carlsbad, Calif.-based Advanced Diabetes Supplies, a large distributor of Dexcom products.

“The records that are required and the way you need to interpret the local coverage determination is difficult,” he said. “We’ll work with the doctor’s office (to get the documentation). Retail pharmacies don’t, and they don’t want to do it because they know how big of a hassle it is.”

Walgreens announced earlier this month that it has launched a new billing solution to allow Medicare beneficiaries who use the Dexcom G6 continuous glucose monitoring system to fill their prescriptions at any of its 9,200-plus locations.

There’s also the service aspect of providing advanced diabetes management products like CGMs, something providers are skeptical that a retail pharmacy can do.

“I just don’t think we’ve seen a Walgreens or a Walmart or a CVS that does pharmacy as a model do the amount of teaching, training and follow-up,” says Mary Ellen Conway, chief compliance officer for Doral, Fla.-based US Med. “We offer a certified diabetes educator for our clients. People have questions that they need answered. It’s not just pick it up and you’re done with these products, as it is with filling a prescription for medications.”

Provider Cynthia Pazos agrees, saying customer service is the best way for providers to compete in the wake of the news.

“We hand hold the patients with these products,” said Pazos, president of New Orleans-based Diabetes Management & Supplies. “We offer the best customer service and have our diabetes educator on standby to help support the patient if they have any trouble. We ensure they stay on the product and we continue to monitor them.”

Walgreens, unfortunately, may have an ally in manufacturers of CGMs, which are working toward having the devices covered as a pharmacy benefit, not a DME benefit. Walgreens says it is also working with other CGM manufacturers to incorporate their products into the new billing model.

“It seems to be easier access for patients (under a pharmacy benefit),” says Lisa Feierstein, president of Raleigh, N.C.-based Active Healthcare. “When it’s DME, it’s subject to deductibles and copays, as opposed to co-insurance.”