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We did it! How to claim the Discovery CGM benefit

For the first time ever in South Africa, people with diabetes raised their voices together, asking medical aids to cover life-changing CGM devices. We started with a petition, then SA Diabetes Advocacy led the charge with #cgm4all, we joined in with the #fingerstickfree movement, and together we made it happen! Discovery Health listened to us. Below, we outline exactly how to claim the Discovery CGM benefit.

What is the Discovery CGM benefit?

Discovery has approved a certain monthly limit for continuous glucose monitors (CGM) and flash monitoring devices. (Not sure what a CGM is? Find out here.)

  • Children up to age 18:
    • Funded up to 100% of the monthly limit of R1560 for Comprehensive and Executive plan types,
    • Funded up to 75% of the monthly limit to a maximum of R1170 for lower plans (except KeyCare)
  • Adults:
    • Comprehensive and Executive plan types: funding up to 75% of the set monthly to a maximum of R1170
    • Adults on all other plan (excluding KeyCare): funding up to 50% of the monthly limit to a maximum of R780

You can see how this works out below – this is based on the costs for FreeStyle Libre sensors, which are the most affordable option currently. (Find out all about the FreeStyle Libre here.)

What will my co-pay be?

So what does this actually look like? That depends what plan you’re on, and how old you are – children under 18 get a better benefit (yay!)

co pays for discovery cgm benefit

This means that even if you’re on hospital plan (the lowest tier), you will only be paying R780 a month for two sensors, rather than R1980! Unfortunately the benefit doesn’t cover Keycare plans this year – we’re working on it next year.

diabetic south africans advocacy and the discovery cgm benefit

How to claim the Discovery CGM benefit?

We have asked Discovery for the simplest possible method to claim the Discovery CGM benefit. Here’s the step-by-step process.

1. Get a prescription

Get a prescription from a specialist (endocrinologist, physician, pediatrician), a GP with a post graduate diploma / degree in diabetology / diabetes, or a family medicine specialist. The prescription should be for 2 x FreeStyle Libre sensors (or other CGM) per month.

2. Give your prescription to the pharmacy

Take your prescription to the pharmacy, or send it on email to one of these dispensing pharmacies:
Pharmacy Direct: newpatients@pharmacydirect.co.za (first time) / care@pharmacydirect.co.za (repeat orders)
CDE Centre Pharmacy: Store@CDEDiabetes.co.za
MKEM: rx@mkem.co.za

3. Confirm your order and co-pay

Depending on your plan, age and which CGM you choose, there will be a co-pay. The co-pay will apply immediately at the time of collecting the sensors at the pharmacy or before they are delivered.


Important notes about the Discovery CGM benefit:

  • You don’t have to wait till you see your doctor for a prescription: you can get a prescription remotely (on email).
  • Co‐payments will be covered from Medical Savings (if you have them), accumulating to external medicine items as per current benefit and plan type. This will fund from day-to-day benefits, to the maximum of the external medical item limit where applicable.
  • If you buy the sensors from an online store (CDE or M-KEM), you will have to pay in full and then claim from Discovery.
  • The risk funding is for sensors only – any readers or transmitters are still funded from day-to-day benefits; so this will be additional co-pay if members need these.
  • You can download the FreeStyle LibreLink app for free, so that you don’t have to buy a reader for the FreeStyle Libre. (App Store link and Google Play link.)
  • It’s a good idea to connect to LibreView, a free cloud-based data management website, that lets you share your data remotely with your doctor – and Discovery. Find out more at www.LibreView.com

Which CGM to choose?

If you haven’t used a Continuous Glucose Monitor (CGM) before, you might be confused about which sensor to use. Here’s an explanation of what exactly CGM – and flash glucose monitoring – is.

In our opinion, it makes sense to start with the FreeStyle Libre because:

  1. It is the most affordable – you will have the smallest co-pay because it’s the cheapest on the market currently.
  2. If you’re starting out with CGM, it is an easy entry – it’s small, easy to apply and doesn’t require fingerstick calibrations (having to check the accuracy with a blood glucose test).
  3. Unless you suffer from hypo unawareness or you have a child who needs alarms when their blood sugar goes high or low, it is probably enough for you. If you try the FreeStyle Libre and find that you need alarms, it will be much easier to motivate to your medical aid to cover a more expensive CGM.

How to take advantage of the Discovery CGM benefit

You can get started with this benefit today! Ask your doctor for a prescription, follow the steps above, and you’ll soon be taking advantage of it. It’s important to use these devices properly, though. Abbott offers free support and training (virtual sessions) – simply call 0800 222 688 to sign up. If you have a sensor that fails, they also replace them if you call this helpline (a new sensor will be sent to you within a few days).

thank you discovery for listening to south african diabetics

Let’s thank Discovery!

It took a long time and a lot of effort, but Discovery has listened to South Africa’s Type 1 diabetics, and we need to thank them for that! Please make a noise on social media, tagging @discovery_sa and using the hashtag #fingerstickfree so that we can show Discovery how grateful we are that they are supporting us in living our best lives with diabetes.

Not on Discovery? Raise your voice on social media to let your medical aid know you’re not happy! And sign up for the SA Diabetes Advocacy mailing list – we’re also targeting the other medical aids to ask them why they can’t match Discovery’s benefit.

What to read next?

Your options on the Discovery CGM Benefit: There are 3 CGM / flash glucose monitors available in South Africa. Here’s what they are, and how much they cost.

What is a CGM? Flash glucose monitoring and CGM: Not sure what the difference is, or what these words mean? Read this article.

Everything you need to know about the FreeStyle Libre: We gathered all your questions and answered them – here’s all about the Libre.

Photo by Kelly Sikkema on Unsplash

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14 Comments

  1. RICHARD RICHARD

    Not happy with the advertising, it’s not demographically representative of the country,

    Are we saying only a certain demographic will get these benefits or are we saying that only a certain demographic suffers from this illness,

    I’m not quite sure but as far as I am aware, discovery needs to be a fully integrated in every effort to represent everyone in the country

    • Hi there!
      I’m not sure what advertising you’re referencing here? We’re certainly not saying only a certain demographic will get the benefits, or only a certain demographic has diabetes.

  2. SS SS

    What about type 2 diabetics

    • This year the cover is just for Type 1, but the goal is to motivate for Type 2s next year (this is usually the model that works in other countries). You can individually motivate for CGM to be covered, but you need your doctor to write you a letter.

  3. spyrezaike spyrezaike

    This is wonderful news! However the information is slightly different from what Discovery told me. I was informed that Discovery would pay a total of R780 a month, which means the co-payment is actually R1200. Fairly cheap of discovery, but at least a step in the right direction.

  4. Mariana Mariana

    Hi all
    i have explored all the campaigns on the Discovery Did it, but really, what is the benefit here?
    Currently my blood glucose test strips are covered under my Chronic Medicine list and there is no co payment on the consumables to test my glucose
    Here there is a monthly co payment of R780 from your Savings to make use of this Flash Glucose System? If you dont have savings, then you need to pay in for obtaining the x 2 sensors to use on the Libre Freestyle?
    Why cant the x 2 sensor consumables be listed in the Chronic Medicine Basket?
    I need a CGM that alerts my blood sugar levels especially in the early morning , however the Libre 2 apparently does have these benefits , but once again this is not covered?
    My confusion here, where is the actual benefit now here?
    Besides paying a very high monthly contribution towards the medical aid premium and using MSA for the consumables, should this be part of the Prescribe List of consumables to ensure T1 Diabetes make use of the latest and greatest technology?

    • Hi Mariana!
      Thanks for your comment. The benefit is that instead of paying R2000 a month (the current cash price for 2 x FreeStyle Libre sensors), you only have to pay R780 (if you’re on hospital plan – R390 or R0 if you’re on a higher plan or younger than 18). If you’re happy with testing strips then there’s no need to switch, but having a flash glucose monitor like this gives you 24/7 data on your blood sugar. If you need alarms then the more expensive CGMs are a better option for you – in that case you get a R780 contribution so the co-pay is much higher (here are the options: https://sweetlife.org.za/your-options-on-the-discovery-cgm-benefit/).
      It would be great if they were covered in the Chronic Medicine Basket, but this is a good first step – no other medical aid is covering CGM at all at the moment.

  5. Stephen Cilliers Stephen Cilliers

    If u need alarms with the Libre patch, CDE sells the MiaoMiao (https://cdeonline.co.za/product/miaomiao-2/) , which is a ‘dongle’ that fits over the patch, is waterproof and rechargeable and sends data to yr cellphone via Bluetooth. The open-source Xdrip+ app gives a wealth of monitoring/alarming features and allows me to get alerts and monitor my wife’s glucose levels remotely while I’m away at work!

    After ordering the last two patches online, I sent all the relevant info/prescription etc. to Discovery, but they simply whipped the entire amount out of my MSA account, and refunded me directly! All my wife’s other insulin etc. is delivered via Medipost and covered automatically by the chronic allowance.

    I really don’t understand why these patches have remained ‘exclusive’ to limited suppliers for so many years and have never been available via the normal channels! I can only think that there must be some shady corruption issue at work here!!!

    • Thanks for this, Stephen! I don’t think it’s anything shady, I think it’s more that they’ve set up preferred suppliers that they send to in bulk so they can offer a discounted price. If you order from CDE (not CDE Online store, but the pharmacy), M-Kem or Pharmacy Direct, you’ll get the R780 refund for two sensors a month – I’ve tested it. But you need a valid doctor’s prescription first, have you got that?
      Sorry for the frustration!

What do you think?

Sweet Life is a registered NPO/PBO (220-984) with a single goal: to improve diabetes in South Africa. We are funded by sponsorships and donations from aligned companies and organisations who believe in our work. We only share information that we believe benefits our community. While some of this information is linked to specific brands, it is not an official endorsement of that brand. We believe in empowering people with diabetes to make the best decisions they can, to live a healthy, happy life with diabetes.