General information, not medical advice or an insurance coverage decision. MedraxDME operates as an out of network supplier. Coverage, supplier enrollment requirements and patient responsibility depend on the plan and an individual review.
Preferred CGMs belong in the NYRx pharmacy pathway
New York’s June 2024 billing update moved products in the Preferred Diabetic Supply Program to Medicaid enrolled pharmacies. DMEPOS suppliers cannot dispense those preferred CGMs under the old DME pathway. The notice distinguishes other devices and Medicare crossover claims; those situations require their own review.
This means finding a CGM on a DME catalog is not enough. Before requesting a transfer, ask whether the proposed dispenser is an enrolled pharmacy for the specific NYRx benefit. If it is not, ask your plan or NYRx resources to help locate an appropriate enrolled pharmacy rather than starting an unsupported order.
Check the current NYRx criteria
The NYRx guide revised October 22, 2026 identifies a gestational diabetes pathway and a type 1 or type 2 diabetes pathway involving insulin or pump use, an appropriate enrolled prescriber, continued clinical visits and the ability to respond to CGM alerts. Prescribers should use the current requirements when supporting a request.
Bring questions about the clinical criteria to your treating professional. The role of this guide is to help you organize the request; it cannot determine medical necessity, choose treatment or confirm benefits. Do not make changes to insulin or monitoring based on a coverage summary.
Match the preferred product and authorization channel
Ask the pharmacist to compare the exact device with the preferred supply list and current covered product numbers. If the prescriber recommends a different device, ask which authorization route applies. The state’s preferred and nonpreferred processes are not interchangeable. NYRx explains the separate submission routes.
A useful request names the complete system rather than only “Dexcom” or “Libre.” Ask whether you need a first receiver, recurring sensors, or a separate transmitter. If an insulin pump is part of the setup, ask the clinical team to verify compatibility before the pharmacy changes the sensor model.
Use the member help tools before paying privately
The eMedNY member benefits page explains how to locate an enrolled pharmacy and discusses prior authorization. It also cautions that reimbursement may not follow automatically if a person pays privately rather than waiting for required approval. Contact the program about your circumstances before making that decision.
When you call, ask the pharmacy to explain the precise claim response. Was the product number wrong, was the authorization absent, was the pharmacy outside the correct pathway, or was the refill attempted too early? Ask for a written or printable response that the prescribing office can use. A broad “insurance will not cover it” does not identify the next action.
Keep a clear record of the request
Create a short checklist for yourself: prescribing office contact, dispensing pharmacy, exact product, date requested, authorization reference if issued, and the person responsible for the next step. Keep personal insurance information in your own records and share it only through appropriate provider or plan channels.
If you receive a denial, preserve the complete notice. Ask the prescriber whether missing documentation can be corrected or whether a formal review is needed. Follow the notice’s deadlines. If a manufacturer is reviewing an early sensor failure at the same time, keep that case separate so a warranty replacement is not mistaken for the next scheduled refill.
Transfers and other insurance need an individual check
Ask your current pharmacy about open claims before transferring. Ask the new pharmacy when it expects to be able to process the next prescription and whether it needs the existing authorization information. Do not cancel a functioning supply arrangement until the responsible providers have clarified the transition.
Members who also have Medicare should ask how the primary claim and any Medicaid coordination will be handled. A child’s request should be reviewed with the prescriber for applicable pediatric rules and device labeling. Neither scenario can be resolved simply by selecting a product online or by treating all Medicaid programs as identical.
MedraxDME is an out of network supplier. This educational page does not establish Medicaid enrollment, a contract with your plan, or your eligibility to receive equipment from us. Confirm the dispensing provider with your program before transferring a prescription. Our online form requests contact details and optional equipment selections. Do not enter insurance numbers, medical records or glucose readings.
Questions and answers
Can any DME supplier dispense preferred NYRx CGMs?
No. New York routes preferred program CGMs through Medicaid enrolled pharmacies. Confirm the dispenser’s eligibility for your request.
Does this page establish MedraxDME participation in NYRx?
No. Provider enrollment, benefit routing and an appropriate dispensing arrangement must be verified separately.
What should I do if the pharmacy says the request cannot be processed?
Ask for the precise claim response and share it with your prescribing office through an appropriate channel. A processing problem and a clinical denial are different issues.
Sources and updates
- New York CGM pharmacy routing update
- NYRx Preferred Diabetic Supply Program, revised October 2026
- eMedNY member benefits and pharmacy information
Read our editorial and correction policy. For current plan rules, check the applicable official policy and contact your plan. Tell us about a correction.