Effective for fill dates on or after July 1, 2026 for some Tufts Health Direct members and Jan. 1, 2027 for others (see below), we will no longer provide coverage for Dexcom continuous glucose monitors (CGMs) and their accompanying supplies — including new starts and those with previous approvals. 

For existing utilizers, we’re implementing this change in two phases, based on the length of time the member has been utilizing a Dexcom CGM. Existing prior authorizations will terminate at 11:59 p.m. on the dates below:

  • June 30, 2026 — members who will have been utilizing their CGM for greater than one year as of July 1, 2026.
  • Dec. 31, 2026  — members who will have completed at least one year of utilization by Jan. 1, 2027.

FreeStyle Libre (Abbott) flash CGMs and their accompanying supplies are the preferred product, and Dexcom G6 and Dexcom G7 will be considered non-formulary. For existing utilizers who have received a prior authorization for a Dexcom CGM product, members will have an authorization entered for a FreeStyle Libre CGM, and the provider will need to write a new prescription for a FreeStyle Libre flash CGM for the patient to fill at the pharmacy. These members will receive a letter notifying them of this update and instructing them to speak with their provider to obtain the necessary FreeStyle Libre prescription. 

For all new starts, FreeStyle Libre and its accompanying supplies will continue to require prior authorization and will be reviewed against the criteria outlined in the Pharmacy Medical Necessity Guideline (PMNG) for Insulin and Diabetes Supplies.

Non-formulary exceptions for Dexcom CGMs

In order for a member to continue using a non-formulary Dexcom product, the prescribing provider must request coverage through the medical review process subject to the criteria in the Non-Formulary Exceptions PMNG. Should a request for any of these products be approved, members will have to fill their CGM and its supplies at the pharmacy as they will not be available through the DME supplier. 

All CGMs subject to review and limitations

As a reminder, all CGMs (both preferred FreeStyle Libre CGMs and Dexcom products requested via a formulary exception) are restricted with quantity limitations and can only be obtained when the prescribing provider has requested coverage through the medical review process subject to the Insulin and Diabetes Supplies PMNG via the Pharmacy Utilization Management Department fax at 617-673-0988.