Medicare now covers continuous glucose monitors (CGMs) when you get them through a pharmacy instead of only through medical suppliers

For years, Medicare covered CGMs only when ordered through a Durable Medical Equipment (DME) supplier — the medical supply companies that also provide wheelchairs, oxygen, and other equipment. Starting in 2024, Medicare began covering CGMs dispensed directly by pharmacies, which means you can now pick up your sensor at the same place you get your prescriptions filled. This is new, and it changes where and how you obtain your CGM.

The pharmacy route does not replace the DME route — both still exist. But the pharmacy option may be faster or more convenient depending on which pharmacies participate in your area and which supplier your doctor prefers to work with. Understanding both paths helps you and your doctor choose what works best for your situation.

Key Takeaways

  • Medicare covers CGMs through participating pharmacies as of 2024, in addition to the existing coverage through DME suppliers.
  • Your doctor must write a prescription for the CGM, whether you fill it at a pharmacy or order through a DME supplier.
  • Not all pharmacies participate in Medicare's CGM program, so you will need to check with your pharmacy or call Medicare to find participating locations near you.
  • Your out-of-pocket cost (copay or coinsurance) may differ between the pharmacy and DME routes, so it is worth comparing before you choose.
  • You still need to meet Medicare's coverage rules for CGMs, which require either insulin use or frequent blood sugar testing.

What changed and when

Medicare's decision to cover CGMs through pharmacies took effect January 1, 2024. Before this date, the only way to get a CGM covered by Medicare was through a DME supplier — a company your doctor would refer you to, and that company would ship the sensor to your home or have you pick it up at their location.

The pharmacy option does not mean DME suppliers are going away. Many people still use DME suppliers, and your doctor may have an established relationship with a particular supplier. The pharmacy route straightforward gives you another choice, particularly if you have a pharmacy you already trust or if a participating pharmacy is more convenient than the nearest DME supplier.

How to find a participating pharmacy

Not every pharmacy in the United States participates in Medicare's CGM program. Large chains like CVS, Walgreens, and Walmart have locations that participate, but not all of their stores do. Independent pharmacies may or may not participate depending on their agreements with Medicare.

To find out which pharmacies near you carry CGMs under Medicare, call Medicare directly at 1-800-MEDICARE (1-800-633-4227) and ask which pharmacies in your ZIP code are enrolled. You can also ask your current pharmacy whether they dispense CGMs to Medicare patients. If your preferred pharmacy does not yet participate, you can ask the pharmacy manager whether they plan to enroll — some are still in the process of setting up their systems.

What your doctor needs to do

Your doctor must write a prescription for the CGM, just as they would for any other medication or medical device. The prescription does not specify whether you will fill it at a pharmacy or order through a DME supplier — your doctor straightforward prescribes the CGM, and you decide where to obtain it.

If you choose the pharmacy route, bring the prescription to your participating pharmacy. If you choose the DME route, your doctor may refer you to a specific supplier, or you can ask your doctor which suppliers they work with. Either way, the prescription is the same starting point.

Medicare's coverage rules for CGMs

Whether you get your CGM from a pharmacy or a DME supplier, you must meet Medicare's coverage requirements. Medicare covers CGMs for people with diabetes who use insulin, or for people who test their blood sugar at least four times per day. If you do not meet one of these conditions, Medicare will not cover the CGM regardless of where you try to obtain it.

Your doctor will need to document that you meet one of these requirements when they write the prescription. The pharmacy or DME supplier will verify this information with Medicare before dispensing the sensor. If there is a question about whether you meet the criteria, Medicare may request additional information from your doctor before approving coverage.

Cost and coverage details

Your out-of-pocket cost depends on your specific Medicare plan and whether you have supplemental coverage. Under Original Medicare (Parts A and B), you typically pay 20 percent coinsurance after you meet your Part B deductible. If you have a Medicare Advantage plan, your copay or coinsurance may be different, and some plans cover CGMs with no cost-sharing.

The cost may also vary slightly between the pharmacy and DME routes because they bill Medicare differently. Before you choose where to obtain your CGM, ask both the pharmacy and any DME supplier your doctor recommends what your out-of-pocket cost will be. This comparison takes just a few minutes and can save you money.

Medicare covers the sensor itself and the transmitter (the small device that sends readings to your phone or receiver). It does not cover the receiver if you already own one, though you may be able to use an older receiver with a new sensor depending on the brand.

Switching between pharmacy and DME supplier

You are not locked into one source. If you start with a pharmacy and later want to switch to a DME supplier (or vice versa), you can do so. Your doctor can write a new prescription, and you can fill it at a different location. However, Medicare has rules about how often you can receive a new sensor — typically one every 10 days, up to a certain number per month — so switching frequently will not get you more sensors than you are already covered for.

If you are unhappy with your current source — whether it is a pharmacy or DME supplier — talk to your doctor about switching. There is no penalty for changing, and your doctor can help you find an alternative that works better for your situation.

Frequently Asked Questions

Do I have to use a pharmacy if my doctor usually refers to a DME supplier?

No. You and your doctor can choose whichever source works best for you. If your doctor has an established relationship with a DME supplier and you are happy with that arrangement, you can continue using them. The pharmacy option is available if you prefer it, but it is not required.

What if my pharmacy says they do not carry CGMs?

Some pharmacies have not yet enrolled in Medicare's CGM program, even if they are part of a large chain. Ask the pharmacy manager whether they plan to enroll in the future. In the meantime, you can use a participating pharmacy nearby, or you can ask your doctor to refer you to a DME supplier. Call Medicare at 1-800-MEDICARE to find participating locations in your area.

Will my copay be the same at the pharmacy as at a DME supplier?

It may not be. The two routes sometimes bill Medicare differently, which can result in different out-of-pocket costs for you. Before you choose, call both the pharmacy and the DME supplier and ask what you will owe. This takes a few minutes and helps you make the most cost-effective choice.

Can I use a pharmacy if I have a Medicare Advantage plan?

Yes, as long as the pharmacy is in your plan's network. Check your plan documents or call your plan's customer service to confirm that the pharmacy you want to use is covered. Some Medicare Advantage plans may have different rules about CGM coverage than Original Medicare, so it is worth verifying before you fill your prescription.

What if I need a new sensor before my pharmacy has one in stock?

Talk to your pharmacy about their ordering timeline. Most large chains can order a sensor within a few days. If you need one urgently, ask whether another participating pharmacy nearby has it in stock, or contact a DME supplier as a backup. Your doctor can help you arrange an emergency supply if needed.