Plan Update | Dexcom G7 and OzempicFriday, Oct 13, 2023
Pacific Blue Cross updates pharmacy providers on the Dexcom G7® review and the Ozempic® 1 mg pen shortage.
At Pacific Blue Cross, we aim to keep you informed about the latest changes in health care, which include drug listings, policy updates and other important information.
Dexcom G7® under review
The Dexcom G7® is a new Continuous Glucose Monitor (CGM) that came to market in October 2023. The Dexcom G7® is currently under review and is not a benefit under Pacific Blue Cross (PBC) plans at this time.
Glucose monitoring systems currently eligible under PBC plans include the Dexcom G6® and FreeStyle® Libre 2. For more information, please visit the BC Government’s Diabetes PINs website. Members who reside outside of BC should continue to fill out the appropriate PBC Prior Authorization form.
As you may know, there is a shortage of the Ozempic® 1 mg pen, which is expected to improve near the end of October. Ozempic® 0.25 mg and 0.5 mg are not affected by the shortage, but there may not be enough supply to accommodate patients on the 1 mg dose.
To address this shortage, BC PharmaCare has provided temporary coverage for dulaglutide (Trulicity®) as an alternative option with pharmacists able to adapt most prescriptions without consulting the prescriber due to the supply shortage. For more information please refer to the BC PharmaCare Newsletter.
Some pharmacies are compounding semaglutide products in response to the 1 mg pen shortage – this is NOT covered by Pacific Blue Cross. Compounded semaglutide claims will not be accepted for reimbursement and will be subject to auditing.
Lastly, to ensure accurate claim payment for Ozempic®, always indicate the correct quantity. PBC follows correct quantities for PharmaCare claims.
The correct quantity for Ozempic® is volume of one pre-filled pen in milliliters:
- OZEMPIC® 2MG/PEN PRE FILLED 0.25/0.5MG/DOSE (DIN 2471477): 1.5 mL
- OZEMPIC® 4MG/PEN PRE FILLED 1MG/DOSE 3ML (DIN 2471469): 3.0 mL