Diabetic Supplies for Colorado Option Members

DEXCOM G6 RECEIVER*
DEXCOM G6 SENSOR DEVICE*
DEXCOM G6 TRANSMITTER DEVICE*
DEXCOM G7 15-DAY SENSOR DEVICE*
DEXCOM G7 RECEIVER*
DEXCOM G7 SENSOR DEVICE*
FREESTYLE LIBRE 14 DAY READER*
FREESTYLE LIBRE 14 DAY SENSOR KIT*
FREESTYLE LIBRE 2 PLUS SENSOR DEVICE*
FREESTYLE LIBRE 2 READER*
FREESTYLE LIBRE 2 SENSOR KIT*
FREESTYLE LIBRE 3 PLUS SENSOR DEVICE*
FREESTYLE LIBRE 3 READER*
FREESTYLE LIBRE 3 SENSOR DEVICE*
GUARDIAN 4 GLUCOSE SENSOR DEVICE*
GUARDIAN 4 TRANSMITTER DEVICE*
GUARDIAN LINK 3 TRANSMITTER DEVICE*
GUARDIAN SENSOR 3 DEVICE*
MINIMED APP MANAGER*
MINIMED INSTINCT SENSOR DEVICE*
SIMPLERA SENSOR DEVICE*
SIMPLERA SYNC SENSOR DEVICE*

*Prior Authorization is Required 

Covered for 2026 and 2027 plan years. Covered items are subject to change.

Updated 10/28/26

CEQUR SIMPLICITY DEVICE 1 UNIT
ILET INSULIN PUMP*
ILET INFUSION KIT-FLEX 23" COMBO PACK
ILET INFUSION KIT-INSET 23" COMBO PACK
ILET INFUSION KIT-INSET 32" COMBO PACK
ILET INFUSION-CONTACT DTCH 23" COMBO PACK
ILET STARTER KIT CONTACT KIT
ILET STARTER KIT-INSET KIT
CEQUR SIMPLICITY DEVICE 2 UNIT
CEQUR SIMPLICITY INSERTER
MINIMED 780G INSULIN PUMP*
MINIMED FLEX*
MODD1 SUPPLY KIT*
MODD1 PATIENT WELCOME KIT*
OMNIPOD 5 (LIBRE 2/3 PLUS) SUBCUTANEOUS CARTRIDGE
OMNIPOD 5 G6-G7 INTRO KT (GEN5) SUBCUTANEOUS CARTRIDGE
OMNIPOD 5 G6-G7 PODS (GEN 5) SUBCUTANEOUS CARTRIDGE
OMNIPOD 5 INTRO (LIBRE 2/3 PLUS) SUBCUTANEOUS CARTRIDGE
OMNIPOD DASH INTRO KIT (GEN 4) SUBCUTANEOUS CARTRIDGE
OMNIPOD DASH PDM KIT (GEN 4)
OMNIPOD DASH PODS (GEN 4) SUBCUTANEOUS CARTRIDGE
PIVOT INSULIN PUMP STARTER KIT*
T:SLIM X2 CONTROL-IQ*
TANDEM MOBI AUTOSOFT 30 KT 23" COMBO PACK
TANDEM MOBI AUTOSOFT XC KIT 5" COMBO PACK
TANDEM MOBI AUTOSOFT XC KT 23" COMBO PACK
TANDEM MOBI AUTOSOFT30 14PK 23 COMBO PACK
TANDEM MOBI AUTOSOFTXC 14PK 23 COMBO PACK
TANDEM MOBI AUTOSOFTXC 14PK 5" COMBO PACK
TANDEM MOBI SYSTEM*
TANDEM MOBI TRUSTEEL KIT 23" COMBO PACK
TANDEM T:SLIM ASFT 30 PK10 23" COMBO PACK
TANDEM T:SLIM ASFT 30 PK14 23" COMBO PACK
TANDEM T:SLIM ASFT XC PK10 23" COMBO PACK
TANDEM T:SLIM ASFT XC PK14 23" COMBO PACK
TANDEM T:SLIM X2 SARTER KIT*
TANDEM T:SLIM TRUSTL PK10 23" COMBO PACK
TWIST STARTER KIT
TWIST Rfl
V-GO 20 DEVICE
V-GO 30 DEVICE
V-GO 40 DEVICE

*Prior Authorization is Required 

Covered for 2026 and 2027 plan years. Covered items are subject to change.

Updated 10/28/26
 

Freestyle Freedom Lite Kit
Freestyle Insulinx
Freestyle Lite Meter Kit
Freestyle Precision Neo Meter
Freestyle System Kit
Precision Xtra Monitor
Freestyle Insulinx Strips
Freestyle Insulinx Test Strips
Freestyle Lite Strips
Freestyle Precision Neo Strips
Freestyle Test Strips
Freestyle Xtra Test Strips

Please see "Blood Sugar Diagnostics" category in the prescription drug list (formulary) for a complete list of covered Test Strips.

Covered for 2026 and 2027 plan years. Covered items are subject to change.

Updated 10/28/26

Freestyle Lancets 28 Gauge
Freestyle Unistik 2

Please see prescription drug list (formulary) for complete list of covered Lancets, Syringes and Needles.

Covered for 2026 and 2027 plan years. Covered items are subject to change.

Updated 10/28/26

 INPENS

Please see prescription drug list (formulary) for complete list of covered Inpens.

Covered for 2026 and 2027 plan years. Covered items are subject to change.

Updated 10/28/26

• To learn more about a product on this list, check your prescription drug list (formulary) for tier information, coverage rules, and any limits (such as quantity limits).
• To find an in-network pharmacy, check the pharmacy directory by signing in to your MedImpact member portal. MedImpact is our pharmacy service provider.
• Have your pharmacy submit a claim to MedImpact to process the claim under your pharmacy benefit.

If you have more questions about your pharmacy benefits, please contact us by calling 303-602-2070. 

If your plan requires pharmacy prior authorization for a diabetic supply, your healthcare provider (doctor, nurse practitioner, etc.) will give us information about your diagnosis, treatment history and other relevant information to request pharmacy prior authorization. If the pharmacy prior authorization request is approved, you will pay a $0 cost share, not subject to a deductible.

Patients: 
Your doctor will need to submit a pharmacy prior authorization request. 

Providers: 
For more about pharmacy benefits, please contact MedImpact by calling 1-800-788-2949, faxing 1-858-790-6022 (preferred method) or submit an online pharmacy prior authorization request.