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.

UPDATE: The Discovery CGM Benefit was updated and improved in 2022.
Click here to read about the update.

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!)

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.

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).

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