If they do not have a compatible receiver, they will get a new Dexcom G6 receiver. Please note you will need to be registered with Fair PharmaCare. here. Stay up to date on the latest Dexcom G7 news, availability dates, system features, and more! Dexcom Tech support - 1-844-607-8398 5.99.14 Section: Prescription Drugs Effective Date: July 1, 2020 Subsection: Miscellaneous Products Original Policy Date: August 24, 2018 Subject: Continuous Glucose Monitors Page: 1 of 4 Last Review Date: June 18, 2020 Continuous Glucose Monitors (CGM) Description Dexcom G5 CGM System, Dexcom G6 CGM System, Freestyle Libre 10 If you are not affiliated with a DEP registered with the ADP, you will need to refer individuals who meet the ADP medical eligibility criteria to an ADP registered clinic. All Dexcom G6 CGM purchases covered by BC PharmaCare need to be made at your pharmacy. Send the patients certificate of medical necessity (CMN) and chart notes to the distributor, Let your patient know that they will be contacted by the distributor regarding their Dexcom G6 order, 92% of Dexcom Medicare patients report that they are somewhat to extremely satisfied with product ease of use.4, The Medicare copay for Dexcom G6 is the same price as other CGM brands.5, Studies show that Dexcom CGM use is clinically proven to increase time in range.7-9. All patients in Ontario with type 1 diabetes who meet the medical eligibility criteria, or would have met the medical eligibility criteria before they started on the Dexcom G6, should be referred for an assessment at an ADP registered clinic regardless of their current insurance status. Yes. Receiver is required to be used along with smart device in order to receive Medicare benefits for CGM. For more information, view our privacy policy. When presenting your prescription at the pharmacy, your pharmacist will submit the coverage claim to BC PharmaCare and, when needed, coordinate coverage between BC Pharmacare and private insurance. Seek medical advice and attention when appropriate, including for any medical emergency. Initially users will be covered for one year. All rights reserved. Contact your primary care provider or diabetes specialist to initiate the Special Authority approval process and to request a prescription for the Dexcom G6 CGM. %
riaG1SO[Y!AA~ 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). Once approved, bring your prescription to your local pharmacy. Sign up to receive our monthly email newsletter, tips for healthy living, and important updates. Eligible members* can earn up to $100 on their MyBlue Wellness Card by participating in the program. commitment to long-term diabetes follow-up through regular assessments by diabetes educators, and prescribers at intervals deemed appropriate by the Diabetes Education Program; agrees to share the data components of the Ambulatory Glucose Profile (AGP) with the diabetes health care providers/team such as: precent time in target range, percent time above or below target range, precent time in hypoglycemia, visual representation of average 24-hour glucose profile for a 2-week period. For the full list of Medicare coverage criteria, visit the Centers for Medicare and Medicaid Services website. All new and existing Pacific Blue Cross members must now apply for BC PharmaCare coverage of the Dexcom G6 CGM. 2021;27(6):505-537. CGM devices covered by Medicare are defined in CMS Ruling 1682R as %PDF-1.5
The existing Detailed Written Order (DWO) will be honored. If a member receives coverage through BC PharmaCare, Pacific Blue Cross will coordinate that coverage. A patient must call their plan to confirm that the distributor is in their network. We chose to shift all Medicare distribution to our trusted distributors, so we can more fully focus on developing innovative continuous glucose monitoring (CGM) systems that simplify and improve diabetes management for people around the world. This is also called blood glucose. The process for Pacific Blue Cross members to obtain coverage of the Dexcom G6 CGM is changing. The PDL is a list showing the drugs that can be covered by the plan. and our Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. Dexcom, Dexcom G6, Dexcom G5 Mobile, Dexcom G4 PLATINUM, Dexcom Follow, Dexcom Share, This means they will automatically get a new Dexcom G6 transmitter and sensors with instructions on how to update the receiver and app. Over the next several months the Dexcom G6 online store will be phased out. My endo thankfully jumped through the hoops and now mine is 100% covered. The initial approval duration is two years. People living with diabetes can gain valuable insight about their glucose levels, rate, and direction of change, allowing them to proactively manage their diabetes. Where can patients fill their Dexcom G6 scripts? <>
There is no change for any other CGM or Flash Glucose Monitor (Freestyle Libre or Libre 2) at this time. Non-invasive CGM and related supplies are considered experimental/investigational, and therefore, non-covered because the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature. Through a variety of programs and resources, were committed to helping you manage diabetes and take an active role in your health. ( OVtN Glucose results are used by the individual to closely monitor their glucose levels to help them to better self-manage their diabetes. Pacific Blue Cross members must now apply to PharmaCare for Dexcom G6 CGM coverage. Standard and Basic Option members with diabetes can earn rewards through our Diabetes Management Incentive Program. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Dexcom G6 is available at the distributors listed below. If your glucose alerts and readings from the Dexcom CGM do not match symptoms, use a blood glucose meter to make diabetes treatment decisions. <>
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. To be eligible for coverage, individuals must meet the following Medical Eligibility Criteria: For your patients living with type 1 diabetes that meet the medical eligibility criteria stated above, they will need to be assessed and followed by healthcare professionals associated with a Diabetes Education Program (DEP) registered with the ADP. 9 Martens T, et al. NOTE:In addition to the above criteria, product specific dosage and/or frequency limits may apply in accordance with the U.S. Food and Drug Administration (FDA)-approved product prescribing information, national compendia, Centers for Medicare and Medicaid Services (CMS) and other peer reviewed resources or evidence-based guidelines. aIJ'%d>8odMw|;
dK^OpX`BHb 5 Centers for Medicare & Medicaid Services, Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs. I know plans are different, but BCBS only covers Dexcom under DME and your endo has to include why you need it over regular glucose monitor (high A1C, hypo unaware, etc). Personal CGM systems can exist as a stand-alone system or integrated with an insulin pump. This process . The Dexcom G6 is now available for patients who meet the Medicare coverage criteria. BC PharmaCare will not retroactively reimburse patients for benefits purchased before approval of a Special Authority request. · Proven clinical outcomes. 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. Learn more. <>>>
No changes will be made for coverage of other CGM devices. *Medicare covers Dexcom G6 for insulin-requiring patients who meet the Medicare coverage criteria. Dexcom G6 is part of the Medical Supplies and Devices class and treats Diabetes Type 2 and Diabetes Type 1.Medical supplies and devices are prescription and over-the-counter items used to assist in the treatment of various medical conditions such as dry mouth, diabetes, asthma, and nausea.They work cooperatively with prescription medications or can be used alone to treat or test for certain . 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. After that time, coverage may be renewed for 5 years if users continue to require intensive insulin therapy and their health care professional recommends that they would benefit from continued CGM use. %
What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. Florida Blue HMO, an afliate of Florida Blue. 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. To continue receiving ADP coverage, patients must meet the Renewal Eligibility Criteria and complete the Renewal Form to confirm their continued eligibility every two years. 1 0 obj
I'm wondering if those of you who use Blue Cross Blue Shield are able to get Tandem and Dexcom supplies. Insulin, an important hormone made by the pancreas, allows sugar from food to turn into energy for your cells. ADP coverage for Dexcom G6 rtCGM is available for adults and children (2 years and older) living with type 1 diabetes, who are residents of Ontario and have a valid Ontario health card. Privacy Policy. To view a list of compatible smart devices, visit dexcom.com/compatibility. Everyones health insurance plan is different. Privacy Policy. Dexcom G6 supplies will be delivered at no cost to your patient. information and promotional communications related to Dexcom products. 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. 8 Welsh JB, et al. Fargo, N.D., 58121. 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. 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. Source:Centers for Disease Control and Prevention (CDC)&American Diabetes Association. JAMA. So apparently under NC's State Health Plan (BCBS) CGM supplies are no longer covered. Dexcom will submit the completed form to ADP on your patients behalf. The patient/family/caregiver agrees to comprehensive and age-appropriate diabetes education by an interdisciplinary diabetes healthcare team and commits to regular follow-up. Click here for important updates on coverage and purchase options. If rejected, Dexcom will notify the patient of their unsuccessful application and discuss their options moving forward. Diabetes occurs when your body is unable to use sugar in the blood. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. stream
The process for Pacific Blue Cross members to obtain coverage of the Dexcom G6 CGM is changing. Diabetes is more common than you may know. 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. Gestational diabetes develops in some women when they are pregnant. What if the patients claim is denied at the distributor? Dexcom will be phasing out its online store over the next several months. Reddit and its partners use cookies and similar technologies to provide you with a better experience. 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. Programs and resources to help you better understand, manage and prevent diabetes. Have private insurance coverage for Dexcom supplies? Easy to use Dexcom CGM is easy to apply, easy to wear, and easy to use.1 See your glucose numbers in real time by simply glancing at your Dexcom receiver or smartphone. Lowers A1C2-6 Using a Dexcom CGM System is proven to lower A1C and help you spend more time in range.2-6 New Patients: Get Started with Dexcom CGM Frequent and unpredictable hypoglycemic episodes. endobj
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@e^NN(eU. ADP will notify Dexcom of the patients application status: Once the patient has been approved, Dexcom will contact the patient to confirm their status and deliver Dexcom G6 supplies directly at no cost. 4510 13th Ave. S. Step 1: Ask your doctor to e-prescribe your Dexcom CGM supplies to your local pharmacy and to confirm coverage with your pharmacist. People with diabetes and other serious underlying medical conditions may be at higher risk for more severe complications from COVID-19. *You must be 18 or older on a Standard or Basic Option plan to earn this reward. To learn more about public coverage for Dexcom G6 supplies, click here. 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. The Dexcom G6 is indicated for users aged 2 and older while the Libre 2 is indicated for ages 4 and older. Medicare patients currently using Dexcom G5 will be automatically updated to Dexcom G6 when their G5 transmitter is out of warranty. At least one functional restriction that inhibits the use of blood glucose test strips (BGTS) (e.g., dexterity, mobility, dermatological problems). Diabetes Management Incentive Program. Prescribers should follow the new patient prescription process. I have used dexcom for over 10 years, dozens of different policies and never denied! Effective January 1, 2022, continuous glucose monitors (CGMs) will no longer be covered under the medical benefit as durable medical equipment for certain Anthem Blue Cross (Anthem) fully insured groups. This is to ensure that the medical devices and medications covered by our plans are the right products at the right price to protect both the health of our Members as well as the sustainability of our plans. 4 0 obj
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~. r-}o|86ZEvtEO Diabetes Overview - Blue Cross and Blue Shield's Federal Employee Program Diabetes Programs and resources to help you better understand, manage and prevent diabetes. Parents or guardians of a child under 18 years of age, living at home and who have a severe disability, may meet the program Eligibility criteria to receive ACSD funding. These products are covered by U.S. patent. For your patients with private insurance, a prescription for Dexcom G6 should be provided with the notation "ADP Pending" written on it, to enable uninterrupted coverage on their private health plan pending ADP determination. 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. 7 Beck RW, et al. Please review the terms of use and privacy policies of the new site you will be visiting. * Dexcom data on file (commercial insurance plans for T1 and T2 patients taking insulin). Also any experience with NC or TN Medicaid and their coverage of CGMs? A Diabetic's Guide: How to Count Carbs Like a Pro. Does Pacific Blue Cross provide CGM coverage? Dexcom Dexcom G5 Mobile CGM A9277 and K0553 Prior authorization is required. Our Diabetes Management Incentive Program is designed to help educate and support members who take an active role in managing their diabetes. What documents must be provided to my insurance company? Your member ID card is your key to using your medical plan benefits. Dexcom, Dexcom Follow, Dexcom CLARITY, and Dexcom Share are registered trademarks of Dexcom, Inc. in the U.S., and may be registered in other countries. The PharmaCare Special Authority form will be the only one required to obtain coverage from Pacific Blue Cross. 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. Covered Diagnosis Codes Billed with Z79.4 for Procedure Codes: 0446T, 0447T, 0448T, 95249, 95250, 95251, A4238, A9276, A9277, A9278, E2102, G0308, G0309, K0553, K0554, S1034, S1035, S1036, S1037, Internal Medical Policy Committee 11-14-2019 Updated policy to mirror pharmacy CGM policy effective 1-1-2020 Blue Cross Blue Shield of Rhode Island maintains the right to audit the services provided to our members, . The ODSP website also contains information on How to apply. 3 0 obj
Yes. T2/2000/Tresiba,Ozempic,Metformin/Dex G6. After that, it may be renewed for five years. For a list of DEP clinics registered with the ADP: https://www.ontario.ca/page/insulin-pumps-and-diabetes-supplies#section-3. Time in range is a powerful supplement to A1C because it shows a more complete picture of changes in glucose levels. Click here to download a PDF summary of the Ontario ADP coverage information. This change applies only to the Dexcom G6 CGM. Also, many Medicare beneficiaries have secondary insurance that covers their copayment. %PDF-1.7
ADP coverage for Dexcom G6 rtCGM is available for adults and children (2 years and older) living with type 1 diabetes, who are residents of Ontario and have a valid Ontario health card. Is Dexcom covered by public insurance plans? Pacific Blue Cross members should first check to see if CGMs are a benefit under their plan. Phone Medicare covers therapeutic CGM devices under the DME benefit. Unlike a blood glucose meter (BGM), which provides just a single glucose reading, CGM systems can provide real-time, dynamic glucose information up to every five minutes. Continuous Glucose Monitoring (CGM) is a method to track glucose levels throughout the day and night. Whats the difference between the Dexcom G6 CGM and the Freestyle Libre 2 System? Step 2: If your doctor confirms your coverage, check your pharmacy voucher eligibility* by registering at dexcom.com/pharmacyoffer Step 3: Visit your designated pharmacy to pick up Dexcom CGM supply refills. Customer Service: 1-844-832-1810 Mon-Fri 9am-8pm EST. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>>
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Rewards through our diabetes Management Incentive Program is designed to help you better understand, manage and prevent.... Showing the drugs that can be covered by BC PharmaCare will not retroactively patients. With an insulin pump be made for coverage of the Ontario ADP coverage information BC PharmaCare, Pacific Cross... In range is a method to track glucose levels to help educate and support members who take an active in! Be provided to my insurance company and its partners use cookies and similar technologies provide... One required to obtain coverage does blue cross blue shield cover dexcom g6 the Dexcom G6 is available at the distributor is in their health no covered! First check to see if CGMs are a benefit under their plan to track glucose levels help... For T1 and T2 patients taking insulin ) insulin pump if the patients is... For T1 and T2 patients taking insulin ) and never denied ; s State health plan ( )...