The monthly cost of a Continuous Glucose Monitor (CGM) per month varies widely based on the device, your insurance, and where you purchase the supplies. A CGM automatically tracks your glucose levels throughout the day and night using a small sensor inserted just under the skin. It eliminates the need for frequent fingerstick checks, providing real-time data invaluable for diabetes management. Because a CGM system is composed of several parts that are replaced at different intervals, the monthly expense is not a simple, fixed price.
Components Driving the Monthly Expense
The sensor is the main item driving the monthly recurring cost of any CGM system. This disposable part measures glucose levels and must be replaced after a specific duration. Latest systems require a new sensor every 10 to 14 days, meaning a user needs two or three sensors monthly for continuous monitoring.
Older CGM systems required a separate transmitter, the reusable component that wirelessly sent data from the sensor to a display device or smartphone. Many current-generation systems, like the FreeStyle Libre 3 and Dexcom G7, integrate the transmitter directly into the disposable sensor unit. This integration eliminates the separate, less frequent cost of a transmitter, but slightly increases the per-sensor price. Initial start-up costs, such as a dedicated receiver device, are typically a one-time expense and are not factored into the monthly recurring cost.
Cash Pricing: The Baseline Cost Without Insurance
The cash price, or the cost without insurance or discounts, represents the maximum expense a user might face and serves as the baseline for savings calculations. For the FreeStyle Libre 3, which uses a 14-day sensor, a one-month supply (two sensors) generally costs $232 to $235 retail. This means the monthly out-of-pocket cost is approximately $116 to $118 per sensor.
The Dexcom G7 uses a 10-day sensor, requiring three sensors for a 30-day supply. The average retail cash price for this three-pack of sensors can range from about $480 to over $570. This makes the monthly expense for the Dexcom G7 system significantly higher than the Libre 3 when a patient pays 100% out of pocket. Calculating the true monthly cost involves multiplying the number of sensors needed by their individual cash price.
Navigating Insurance and Coverage Options
The final monthly cost of a CGM is determined by how your health insurance plan classifies and covers the device. CGMs are generally covered under one of two distinct benefits: Durable Medical Equipment (DME) or a pharmacy benefit. These classifications dictate the rules for patient cost-sharing, including deductibles, co-pays, and co-insurance.
If your plan covers the CGM as a pharmacy benefit, the supplies are treated like a prescription drug. Under this model, you typically pay a fixed co-pay per month, which is often low, ranging from $0 to $75 for commercially insured patients. However, this coverage may only kick in after you have satisfied your annual prescription deductible, which can mean paying the full cash price for the first few months of the year.
Coverage under the Durable Medical Equipment (DME) benefit requires obtaining supplies through a specialized medical supplier. This model, common with Medicare and some commercial plans, typically involves co-insurance. Co-insurance means paying a percentage of the total cost after meeting the annual medical deductible. For example, Medicare Part B covers 80% of the cost, leaving the patient responsible for the remaining 20% co-insurance.
To illustrate the difference, consider a three-pack of Dexcom G7 sensors costing $500 cash. Under a pharmacy benefit, your monthly cost might be a straightforward $45 co-pay after the deductible is met. Under a DME benefit, a 20% co-insurance would require you to pay $100 per month. While the DME payment is higher in this example, it avoids the tiered co-pays or formulary restrictions common with pharmacy benefits. Understanding your plan’s benefit classification is crucial for calculating the final monthly expense.
Strategies for Lowering Out-of-Pocket Costs
Several strategies exist to significantly reduce the monthly expense for patients facing high co-pays or lacking insurance coverage. Manufacturer coupon programs are an effective method to lower costs for commercially insured patients who still have a high co-pay. Manufacturers frequently offer savings cards that can reduce the monthly out-of-pocket expense for sensors by hundreds of dollars.
Patients can utilize discount programs provided by third-party services, which offer savings off the retail cash price at participating pharmacies. These programs can reduce the price of a monthly supply of sensors by over 50%, often bringing the out-of-pocket cost into the range of $150 to $350 per month, depending on the brand. For low-income individuals, patient assistance programs offered by manufacturers can provide supplies at a deeply reduced cost or free of charge if financial and medical criteria are met.
Using tax-advantaged accounts like a Health Savings Account (HSA) or a Flexible Spending Account (FSA) allows users to pay for monthly CGM supplies with pre-tax dollars. This provides substantial savings on the out-of-pocket cost, regardless of the supply source. Comparing prices between different pharmacies and medical suppliers, even with insurance, can also reveal consistent monthly savings.