9 Martens T, et al. Click here for important updates on coverage and purchase options. Covered by MedicareWith expanded coverage for CGM, the Dexcom G6 ContinuousGlucose Monitoring (CGM) System is accessible for more of yourMedicare patients* than ever before. I have been using G6 for almost a year and insurance has provided coverage up until now and I assume the policy changed because now they no longer do. x\moFna?JpRZ; h@?$-QZIT(%K IvvUO~ |s~x3{`w|Y(X6dM~xwP I'&"k$$?c[@K$C RX 8jdA$("m|]^|jRkX"A&A+T8 6m3 W D}hYFu9HXhsc%Xx~GVcmLId*p(Za4P}y/O[=AAH`3>B!\$j\3H1 -$uZETTA\{v7G5SHV2.&DA If CGM devices are a benefit under your plan you can work with your prescriber to obtain coverage through BC PharmaCare. "XgaUkE&*R*j>qQ?Ne3 Z"U^5aNPfbVYIa"x =$;n 363VB[fg9eAep[3?_QSYm_I6c_mU^\xh9*/e`!*t?_o7=98k NT:4kI =`f%kMG8,sVg=y,1(g3cYza% uG9s_PlGp^KUouCU 7G~ypD9y*c5 For a complete description of Medicare coverage criteriavisit theCenters for Medicare and Medicaid services website. Dexcom, headquartered in San Diego, is dedicated to helping people better manage their diabetes by developing and marketing continuous glucose monitoring (CGM) products and tools for adult and pediatric patients. I was just denied coverage for dexcom. Dexcom G6 is available at the distributors listed below. For the full list of Medicare coverage criteria, visit the Centers for Medicare and Medicaid Services website. ( OVtN Personal preference and physician recommendation will determine which device a member should choose. Take note of any annual dollar maximums, copays, or deductibles. As far as I understand it, Dexcom is covered by your pharmacy benefit, not through Anthem. BC PharmaCare will provide coverage to those who are 2 years old and up with diabetes mellitus and require multiple daily injections of insulin or insulin pump therapy as part of intensive insulin therapy. For patients currently using Dexcom G6 who turn 65 (becoming Medicare-eligible), how will they be transitioned to Dexcom G6 for Medicare? stream %PDF-1.5 g9=_ONozKsifm7k =dk!?j jy`-=_}-#|b{i>r*j_rcD(:|\6zs@v8%?-n/kRV[+QTr!9Ih$$%$T3~ o FBTUs]BcYWr0$|]8*rp>in|XKRseNaC4=>d3)id@SQxgXV1R!'yrT&NhaYFXxl(_7 P9yUg=Q\}?&~Ve;d=h_WvERd*s>=Gc(sFlx%l,#*_u1 t(`QP2.]r+X#L1#CO>`?Z .ulNm/ve4L0 e.DGQ!J.89Gqr o}v]>r@? For these members, CGMs will only be covered under their pharmacy benefit. Members residing outside of BC should have their Prescriber or Diabetes Specialist complete the Dexcom G6 CGM request form and return to us for review. ?;E%}p}o]>H7 {"/:|Y }=l~Tx~dEW%[A+ |)Z9D%SE WW@Y\j7+nH! Your member ID card is your key to using your medical plan benefits. Thats about one in every 10 adults. The Dexcom G6 devices offers a similar member experience to the FreeStyle Libre 2 system. CGM systems consist of a sensor, transmitter and receiver. Glucose results are used by the individual to closely monitor their glucose levels to help them to better self-manage their diabetes. Full eligibility criteria can be found below. please fill out the form and a representative will contact you. On June 11, 2021, the Government of British Columbia announced that the Dexcom G6 CGM is now covered through BC PharmaCare for eligible British Columbians. A patient must call their plan to confirm that the distributor is in their network. 0!o!eg[Z'K'xt[ No changes will be made for coverage of other CGM devices. WTF!!!! Requires multiple daily injections of insulin or insulin pump therapy as part of intensive insulin therapy. Some insurances will cover Dexcom glucose monitoring system based on certain criteria. All new and existing Pacific Blue Cross members must now apply for BC PharmaCare coverage of the Dexcom G6 CGM. How long will I be covered for the Dexcom G6? Is Dexcom covered by public insurance plans? Individual private insurance plans may differ and are subject to change. Thats why its important to know your risk factors for type 2 diabetes and see your doctor regularly for blood glucose tests. Dexcom will be phasing out its online store over the next several months. Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically. Why is Dexcom referring patients to distributors? stream Initially users will be covered for one year. BRIEF SAFETY STATEMENT: Failure to use the Dexcom Continuous Glucose Monitoring System and its components according to the instructions for use provided with your device and available at https://www.dexcom.com/safety-information and to properly consider all indications, contraindications, warnings, precautions, and cautions in those instructions for use may result in you missing a severe hypoglycemia (low blood glucose) or hyperglycemia (high blood glucose) occurrence and/or making a treatment decision that may result in injury. Learn more here. Will PBC be making any system enhancements to better support members? For more information on BC PharmaCare coverage and the Special Authority and Fair PharmaCare programs please see the following links: How to apply for Special Authority from BC PharmaCare. Individuals who meet the following criteria will be eligible for BC PharmaCare coverage: An occupation where hypoglycemia presents a significant safety risk (e.g., pilots, air traffic controllers, commercial drivers). N?[;IR. * The process is simple: below and fill out the form provided. Dexcom G6 is also covered by both the Ontario Disability Support Program (ODSP) and Assistance for Children with Severe Disabilities Program (ACSD) as a Mandatory Special Necessities Benefit. The Dexcom G6 Continuous Glucose Monitoring (CGM) System is now covered through BC PharmaCare under Fair PharmaCare. 3 0 obj CGM users insert a tiny sensor wire just underneath the skin with an applicator. Blue Cross Blue Shield of North Dakota is an independent licensee of the Blue Cross Blue Shield Association, serving residents and business in North Dakota. [CDATA[ Qualified individuals for the ADP funding will receive 100% coverage for their Dexcom G6. Follow these two simple steps to get your eligible* Medicare patients quickly started on Dexcom G6. 2023 Dexcom, Dexcom G6, Dexcom G5 Mobile, Dexcom G4, Dexcom Follow and Dexcom CLARITY, Dexcom Share, Share are registered trademarks of Dexcom, Co. in the U.S., and may be registered in other countries. 2023 Dexcom, Inc. All rights reserved. How can HCPs prescribe Dexcom G6 to their Medicare patients? HMO coverage is offered by. You may have pharmacy coverage for Dexcom through your insurance, which would allow you to get supplies at your local pharmacy. permission to process your personal information to send you additional Learn more. Current patients may be eligible to receive ADP coverage for the sensors and transmitters used with their current rtCGM system if they meet all of the following: If your patient meets the criteria listed above, an ADP Application Form may be submitted on their behalf. Your patients may be eligible for CGM if they: For the full list of Medicare coverage criteria, visit the Centers for Medicare and Medicaid Services website. Health insurance is offered by Florida Blue. I'm with Anthem Blue Cross in California. The Freestyle Libre 2 is not a BC PharmaCare benefit. The patient/family/caregiver agrees to comprehensive and age-appropriate diabetes education by an interdisciplinary diabetes healthcare team and commits to regular follow-up. What can I do? If you are interested in obtaining a Dexcom Continuous Glucose Monitoring System and have financial concerns, we offer a free insurance benefits check to see if you are covered. This plan uses a Preferred Drug List (PDL). Retrospective review of glucose data from Dexcom G6 can identify patterns of hyper- and hypoglycemia, as well as glycemic excursions to help guide treatment decisions. Applicant demonstrates experience with and commitment to managing blood sugar control and an ability to use rtCGM safely and effectively by all of the following. Description Continuous Glucose Monitoring (CGM) Systems (also known as Real-Time or interstitial) monitor, measure, and record glucose levels in interstitial fluid and produce data that show trends in glucose measurements. Sorry, you need to enable JavaScript to visit this website. <> The Dexcom G6 is indicated for users aged 2 and older while the Libre 2 is indicated for ages 4 and older. If they do not have a compatible receiver, they will get a new Dexcom G6 receiver. 2021: 65. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. The easiest indication for Dexcom G6 or Dexcom G7 coverage by insurance is insulin use. Wednesday, Jul 21, 2021 The Dexcom G6 Continuous Glucose Monitoring (CGM) System is now covered through BC PharmaCare under Fair PharmaCare. By accepting all cookies, you agree to our use of cookies to deliver and maintain our services and site, improve the quality of Reddit, personalize Reddit content and advertising, and measure the effectiveness of advertising. Phone No, the Dexcom G6 Medicare copayment is the same price as other popular CGM brands. 2023 Blue Cross Blue Shield of North Dakota, Please wait while your form is being submitted, Directory Validation Instructions (No Surprises Act), Recredentialing & Credentialing Applications. &y/Brb4L xDAs?3t%Nufg|{CRt-Jm6lN(+/.}NX[oP4i*V }"WI"+i\mQb}d*W.i}H To ensure a successful transaction, please confirm your submitted First Name and Last Name match that associated wtih your NPI number. 2021;325(22):2262-72. The Dexcom G6 costs approximately $3,600 annually and the Libre 2 Flash is approximately $2,600 annually. Prescribe Dexcom G6 CGM Prescribe Medicare Powerful glucose insights for better diabetes management Proven clinical outcomes Easy to use1 Covered by Medicare With expanded coverage for CGM, the Dexcom G6 Continuous Glucose Monitoring (CGM) System is accessible for more of your Medicare patients* than ever before. Proven clinical outcomes. A copy of the front and back of your insurance card. Through a variety of programs and resources, were committed to helping you manage diabetes and take an active role in your health. Currently, CGM system sensors can be used 3-90 days before replacement. a Dexcom G6 receiver: $417.92 each (or $203.29 membership discount price) estimated total: $4,173 per year for lowest Costco membership, or $347 per month (not counting the optional Dexcom. If rejected, Dexcom will notify the patient of their unsuccessful application and discuss their options moving forward. Personal CGM systems can exist as a stand-alone system or integrated with an insulin pump. You may opt-out of these communications at any time. Eligible members* can earn up to $100 on their MyBlue Wellness Card by participating in the program. aIJ'%d>8odMw|; dK^OpX`BHb To add insurance information to your Dexcom online account, take the following steps: The Dexcom G6 Continuous Glucose Monitoring (CGM) System is covered by Medicare for type 1 or type 2 diabetic patients who meet the Medicare coverage criteria. 2019;21(3):128-132. 2 0 obj The PDL is a list showing the drugs that can be covered by the plan. How can I receive BC PharmaCare and Pacific Blue Cross coverage? As a Blue Cross Community Health Plans SM member, you have coverage for selected generic prescriptions, brand name prescriptions, over-the-counter (OTC) drugs, and selected medical supplies. Check out the changes and updates to our plan in 2023. If you are on 3 or more injections a day and you are testing your blood sugars at least 3-to 4 times a day you will qualify by Medicare criteria. 2022 Dexcom Canada, Co. All rights reserved. Please follow the steps below to obtain BC PharmaCare coverage. Individual has type 1 diabetes and is receiving short- or rapid-acting insulin therapy; Individual has type 2 diabetes and is receiving short- or rapid- acting insulin therapy; Individual has gestational diabetes or is pregnant and a CGM is recommended by the provider; Updated policy to mirror pharmacy CGM policy, Individual has type 1 diabetes and is receiving short- or rapid-acting insulin therapy, Individual has type 2 diabetes and is receiving short- or rapid- acting insulin therapy, Individual has gestational diabetes or is pregnant and a CGM is recommended by the provider. This is the most common type of diabetes. Covered Diagnosis Codes Billed with Z79.4 for Procedure Codes: 0446T, 0447T, 0448T, 95249, 95250, 95251, A4238, A4239, A9276, A9277, A9278, E2102, E2103, S1034, S1035, S1036, S1037, Internal Medical Policy Committee 11-14-2019 Revision -Effective January 01, 2020, Internal Medical Policy Committee 3-16-2020 coding update, Internal Medical Policy Committee 7-22-2020 Revision, Internal Medical Policy Committee 7-22-2021 Coding update, Internal Medical Policy Committee 11-23-2021 Updated description, non-invasive CGM and remote CGM language, Internal Medical Policy Committee 3-23-2022 Coding update-Effective April 01, 2022, Internal Medical Policy Committee 7-21-2022 Coding update -Effective July 01, 2022, Internal Medical Policy Committee 11-29-2022 Coding update -Effective January 01, 2023. The Dexcom G6 device transmits blood glucose results in real time to an app; the Libre 2 requires the user to scan the sensor to get their results. The Diabetes Management Program by Livongo, Centers for Disease Control and Prevention (CDC), Work with a registered dietician to develop a healthy meal plan, Exercise at least 30 minutes a day, 5 days a week, Follow USDA ChooseMyPlate guidelinesfill half your plate with healthy fruits & vegetables, a quarter with protein & a quarter with whole grains, Take prescribed oral medication, insulin or a combination as directed by your doctor. Their plan to confirm that the distributor is in their network wire just underneath skin... Freestyle Libre 2 Flash is approximately $ 2,600 annually personal information to send additional... Of your insurance card Centers for Medicare and Medicaid Services website plans or contact member! Apply for BC PharmaCare coverage xDAs? 3t % Nufg| { CRt-Jm6lN ( +/ just the. Requires multiple daily injections of insulin or insulin pump therapy as part of intensive therapy! 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