Tandem Pump Supplies

Hello! I recently had to switch off of my parents’ insurance and I am now trying to order my first set of pump supplies using the Aetna insurance supplied by my graduate program. However, when I talked to Aetna they said it would cost me over $400/month for infusion sets and cartridges alone (including CGM materials, this will likely put me over $1000/month which I cannot afford). The reason they gave is that these are mail order prescriptions and if I can pick them up from a pharmacy in person, the cost will only be ~$100/month for the pump supplies. However, I have been hard pressed to find any pharmacies in my area that carry the supplies or that will order it to the pharmacy. Has anyone else run into this problem with Tandem supplies and Aetna?

Any advice on how to get these costs down would be much appreciated.

Check with your device rep - I think they are assigned to doctors offices so call your doctor if you need the name. They are pretty knowledgeable about the options in your area.

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Patrick @pandrews, no, I’ve never heard of that happening - although I’ve not been involved with Aetna. Personally, I think it possible that the rep with whom you spoke was fully aware. A few years ago, Walgreens had a mail delivery program for Dexcom which I didn’t need to use, and Abbott Freelance sensors, if you use those are pharmacy items.

I have two suggestions, First - call Aetna customer service again and hopefully get another representative.
Second, call Tandem Customer Support at 1-858-375-1473 [not Teck Support] and ask one of the personnel to assist you. For DexCom Customer Care call 1-877-339-2664.
These folks did my setup and I got delivery on-time without any problems.


In NJ Walgreens can fill Dexcom prescriptions.

That is strange, as most insurance companies have a preferred supplier who ships supply orders at a reduced rate to the insured. My insurance uses Edgepark, However, I found an article that says Dexcom supplies can be purchased at all Wallgreens stores, if proper insurance like Medicare. I have no idea if this is accurate OR if they cover Tandem supplies too, but I’ll send you the link by PM. I am very surprised. The article is dated 2019. I suppose things could have changed or they only cover Dexcom and not Tandem. The summary brochure of your insurance policy should be specific on options and requirements, but with Durable Medical Equipment and diabetic supplies, the details are quite illusive in their material.

I have the same issue. After switching jobs and going from IUnited Health Care where I paid NOTHING for pump supplies and going to Aetna where I pay close to $ 300 a month for pump supplies it has caused me to look for another job. The problem is Aetna they are owned by CVS so they will only allow you to use Mail order through CVS. CVS does not carry Tandem or Dexcom through mail order. They will allow you to order it but only as a monthly prescriptions. I have worked around the Dexcom issue by using google search and buy from pharmacies without a prescription. I can only assume they are selling it so cheap because they are getting discounts from the manufacturer. I found a Dexcom Transmitter for $65 and they never even asked for my Insurance information. I ordered it as soon as I saw it. Should be here in 5 days. Just becareful as it is the internet and not all of the “pharmacies” are Pharmacies. Maybe one day there will be an health insurance company that cares about the well being of people more than the pockets of their board. I doubt it but one can hope.

Hello @Auget welcome to the forum. Hey a quick note here, I have CVS Caremark as my prescription benefit insurer and I can use mail order, Walgreens, CVS pharmacy, and 3 month fills are standard. My copays are the same as when I had other prescription insurers, what’s the big difference? The plans are custom made depending on the company negotiated terms. So CVS for me (which I have no problem with) might be vastly different than CVS for someone else. It’s not typically the insurance, but the company you work for and the employee plan they have. Cheers, I hope you find something that works better for you. good luck.

Joe can i ask what you are paying without being rude? Are you paying more than $250 a month for your pump supplies and CGM supplies? If not what pupmp are you using?

It’s not rude @Auget but it might not be comparable, I work for an international company with 70,000 plus employees. The company has enormous buying power. My copay for diabetes related pharmacy benefit is $20 for 3 months. my infusion sets, and reservoirs are 2 scripts and so I pay $40 for 3 months or $13.33 per month for pump supplies or if I include dexcom, $20 total per month. I would have to look up my cost of insurance but it is subsidized by my company as well. I am using a very old Medtronic pump which I will likely be changing next year to a Tslim or preferably a Mobi (also tandem). I haven’t updated pumps because nothing on the market (until recently) has impressed me enough.

@Auget Thomas the first thing to do is log in to Aetna and download the Evidence of Coverage (EOC) PDF. Search the document for diabetes, pump, CGM, maybe continuous glucose monitor and insulin. The EOC should say something about meters and pumps being covered under your health plan’s pharmacy or “Durable Medical Equipment” (DME) benefits. Note that DME is just a category label applied to all sorts of things that aren’t durable. To be thorough search your plan’s formulary for Tandem and Dexcom also. Let us know what you find and we can point you to some good solutions depending on how your insurance plan covers your supplies.

Dexcom CGMs, even the transmitter, require a prescription to dispense in the US.

@Patrick - I get my Dexcom supplies from CVS at the pharmacy, but I don’t have Aetna insurance. So, I’m not sure why Aetna doesn’t allow you to pick them up there as they do stock them. As Dennis suggested, I would suggest you double-check with Aetna and also call both Tandem and Dexcom to see what they can do to assist. If nothing else, both companies have a “cash price” for these supplies that is, I believe, less than what Aetna has you paying.

~Pam K.
T1D 59.5 years and counting!

PS - Also, if they are covered under DME, as Chris suggested, you should be able to purchase them through your medical plan instead of your prescription drug plan for less. I have had this happen in the past, but didn’t think about it until I saw Chris’ reply. My supplies were fully covered under Medical, while under Prescriptions I was having to pay exorbitant amounts. The prescription plan rep did not inform me of this though. It was my doctor’s office or pump rep who told me to call my insurance and speak to a Medical Plan rep. I did, and as stated, they were all covered. The only thing that I did not like is that I had to get everything through mail order. So, definitely call Aetna, just choose the option for Medical.

~Pam K.

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I did find out the this was covered as a DMS and now I am attempting to use Edgepark. This has been such a nightmare. How is your experience with Wdgepark. This is the first time I am using them and so far I am not impressed. I spoke to them on 4/24 and still I have no supplies yet. They have quoted me 3 different prices, charged my credit card without authorization, quoted my insurance advocate two different prices and still waiting on my sensors to arrive. The only good part is I changed jobs again since the last had such terrible medical coverage and now I have Anthem which seams to be much better than Aetna.

@Auget, I have used Edgepark for a long time, for insurance reasons. Most of the time, I’ve had good service. The exceptions were with large purchases like pumps and transmitters. I won’t rehash what happened, but they do pretty well with my pump supplies. I use Medtronic.

Most of the time, if there’s an issue, they claim they need doctor’s approval. It’s like that every time I get supplies. I don’t get why. It would be like the pharmacy contacting the prescribing physician every month to confirm you need your thyroid medication. When you get a prescription, it’s normally for a year. But this company treats each order as a new prescription. At least that’s how they are with me, It may be due to my insurance, but it’s bizarre to me.

They do process things quickly for me and I get my supplies very promptly.

You can create an online account on their site and order your own supplies. You can check the status of the order that way, as well.

I hope things go smoothly, once it’s sorted out,