CVS Caremark and Aetna are dropping Dexcom from some pharmacy formularies

Here is how to check your coverage and what to do next.

Beginning January 1, 2027, some commercial plans that use CVS Caremark will stop covering Dexcom CGMs through the pharmacy benefit. Not every Aetna plan is affected, so check your plan first. If you are not affected, please still help those who are.

First, find out if you are affected

Call the pharmacy benefits number on your insurance card, even if you haven't received a letter about the change. Ask, "Will my current Dexcom CGM be covered through my pharmacy benefit after January 1, 2027?"

If the answer is vague, ask for a supervisor and do not hang up without a clear answer for your plan.

If the answer is no, ask:

Can my prescriber request a coverage exception, and what documentation do I need?
Can I still get my CGM through my medical benefit as durable medical equipment (DME)? If so, which supplier can I use and what will I pay?

Some Aetna members may still have coverage through their medical benefit. That can mean using a different supplier, meeting a medical deductible, or paying more out of pocket.

If you get coverage through work, your employer's plan may be self-insured, meaning the employer pays the claims and the insurer administers the plan. Self-insured employers often have a say in which devices are covered, so call your benefits team. With a fully insured plan, the insurance company usually has more control over coverage decisions.

If you use an insulin pump, check compatibility before you are switched. Automated insulin delivery systems work only with specific CGMs, so a change can affect how your pump works. Ask your prescriber to document the compatibility issue in their exception request. Approval is not automatic.

If the answer is yes, you can still help the people with diabetes who heard no.

Telling CVS Caremark and Aetna to protect CGM choice

Send a letter through our friends at the Diabetes Patient Advocacy Coalition. If you are affected, tell CVS Caremark and Aetna what a switch would mean for you.

Why this matters

CGMs are not interchangeable. Pump compatibility, caregiver data sharing, direct-to-watch display, Urgent Low Soon alerts, and sensor grace periods can each determine which device works for a person.

A forced switch means new prescriptions, different supplies, retraining, and hours of paperwork in physician offices. It can also leave a gap in access while coverage gets sorted out. For a parent, it can mean relearning how to keep a child safe overnight.

People managing diabetes should not have to change devices for reasons that have nothing to do with their health. We need to protect patient choice, preserve continuity of care, and always put people first.