You may have pharmacy coverage for Dexcom through your insurance, which would allow you to get supplies at your local pharmacy. Insulin, an important hormone made by the pancreas, allows sugar from food to turn into energy for your cells. Follow these two simple steps to get your eligible* Medicare patients quickly started on Dexcom G6. No, the Dexcom G6 Medicare copayment is the same price as other popular CGM brands. F 9Y|wr~;$PTAGC>:2CH!F&Qq& This is also called blood glucose. As such, we will be matching coverage criteria for the Dexcom G6 CGM for our Members. Frequent and unpredictable hypoglycemic episodes. Source:Centers for Disease Control and Prevention (CDC)&American Diabetes Association. 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. #1 preferred CGM system Coverage is subject to the specific terms of the members benefit plan. JAMA. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. Once the Special Authority application has been submitted, approval may take 5-8 weeks. please fill out the form and a representative will contact you. I'm wondering if those of you who use Blue Cross Blue Shield are able to get Tandem and Dexcom supplies. At the assessment appointment, a member of the DEP will confirm the patients eligibility and help them complete the rtCGM application form which will need to be sent to Dexcom. CGM users insert a tiny sensor wire just underneath the skin with an applicator. 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. Will my insurance cover the Dexcom CGM System? At least one functional restriction that inhibits the use of blood glucose test strips (BGTS) (e.g., dexterity, mobility, dermatological problems). To learn more about public coverage for Dexcom G6 supplies, click here. Gestational diabetes develops in some women when they are pregnant. 1 0 obj Most people with type 1 diabetes on commercial health insurance are covered. 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. Following the ADP assessment, the completed application form should be submitted to Dexcom as soon as possible by secure fax at 1-844-348-0784 or by encrypted email at [emailprotected]. Personal CGM systems can exist as a stand-alone system or integrated with an insulin pump. 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. Applicant had severe hypoglycemia in the past 2 years without an obvious precipitant, despite optimized use of insulin therapy and glucose monitoring (at least 4 times/day) which result in one of the following. Qi\rj*G[6[:'D1 }+(ll!X3#eno$)RkigF!oy7 hGpO3i"|d3(@!+& 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 Have private insurance coverage for Dexcom supplies? If a current Dexcom G6 patient ages into Medicare eligibility (i.e., turns 65), they will be treated as a new patient. A Diabetic's Guide: How to Count Carbs Like a Pro. Dexcom will be phasing out its online store over the next several months. Most of the time, it goes away after your baby is born. You can use these rewards to pay for qualified medical . Dexcom has decided to refer all Medicare patients to trusted distributors with experience serving Medicare patients. First Name* Last Name* Phone* Email Address* How would you prefer to be contacted? * The process is simple: Click the link below and fill out the form provided. How do I apply for coverage of the Dexcom G6? The Dexcom G6 devices offers a similar member experience to the FreeStyle Libre 2 system. Are you a current customer facing financial constraints? I'm with Anthem Blue Cross in California. 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. Pacific Blue Cross supports this change, which will provide British Columbians living with diabetes more options for diabetes management. Glucose results are used by the individual to closely monitor their glucose levels to help them to better self-manage their diabetes. These companies are Independent Licensees of the Blue Cross and Blue Shield Association. endobj By continuing to use this website, you consent to these cookies. 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. Check out the changes and updates to our plan in 2023. Most people with type 1 diabetes on commercial health insurance are covered. CareCentrix is an independent company contracted with Florida Blue to manage durable medical equipment. 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. stream You should first contact your primary care provider or diabetes specialist to initiate the BC PharmaCare Special Authority approval process and receive a written prescription. 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. 2021;325(22):2262-72. 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. Replacement is not covered due to loss, negligence or improper use. The PDL is a list showing the drugs that can be covered by the plan. Proven clinical outcomes. Thats about one in every 10 adults. % A copy of the front and back of your insurance card. 4510 13th Ave. S. For more information, view our privacy policy. Dexcom, Dexcom Clarity, Dexcom Follow, Dexcom One, Dexcom Share, and any related logos and design marks are either registered trademarks or trademarks of Dexcom, Inc. in the United States and/or other countries. We are working to enhance our system functionality to improve our Member experience by allowing pharmacies to bill us directly. CGM systems consist of a sensor, transmitter and receiver. After that, it may be renewed for five years. Please note you will need to be registered with Fair PharmaCare. As far as I understand it, Dexcom is covered by your pharmacy benefit, not through Anthem. 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. My endo thankfully jumped through the hoops and now mine is 100% covered. Prediabetes occurs when someones blood sugar levels are higher than normal but not high enough to be classified as diabetes. What if the patients claim is denied at the distributor? g9=_ONozKsifm7k =dk!?j jy`-=_}-#|b{i>r*j_rcD(:|\6zs@v8%?-n/kRV[+QTr!9Ih$$%$T3~ o FBTUs]BcYWr0$|]8*rp>in|XKRseNaC4=>d3)id@SQxgXV1R!'yrT&NhaYFXxl(_7 P9yUg=Q\}?&~Ve;d=h_WvERd*s>=Gc(sFlx%l,#*_u1 t(`QP2.]r+X#L1#CO>`?Z .ulNm/ve4L0 e.DGQ!J.89Gqr o}v]>r@? If a patient is already enrolled with ODSP or ACSD, they may fill out our Consent and Information Form and return it to us by encrypted email at [emailprotected], or by secure fax at 1-844-348-0784. //]]> If your glucose alerts and readings from the Dexcom CGM do not match symptoms, use a blood glucose meter to make diabetes treatment decisions. If approved, your initial BC PharmaCare Special Authority approval period is valid for one year. Pacific Blue Cross members should first check to see if CGMs are a benefit under their plan. %PDF-1.7 In such circumstances, it is recommended to complete a rtCGM Funding Exception Request Form (click to view sample) and submit it along with the ADP Application Form. Does Blue Cross Blue Shield cover Tandem and Dexcom supplies? The PharmaCare Special Authority form will be the only one required to obtain coverage from Pacific Blue Cross. x\moFna?JpRZ; h@?$-QZIT(%K IvvUO~ |s~x3{`w|Y(X6dM~xwP I'&"k$$?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 -$uZETTA\{v7G5SHV2.&DA Copyright 2023 PBC Health Benefits Society. Current patients may be eligible to receive ADP coverage for the sensors and transmitters used with their current rtCGM system if they meet all of the following: If your patient meets the criteria listed above, an ADP Application Form may be submitted on their behalf. 2 0 obj A customer representative will follow up with you to process a full insurance benefits check after reviewing your information. You can check the status of your approval by calling your prescriber or pharmacist to confirm, or by calling PharmaCare at 1-800-663-7100 (toll-free) or 604-683-7151 (from the Lower Mainland). * The process is simple: below and fill out the form provided. However, having it gives you a greater chance of developing type 2 diabetes later in life. endobj stream Medicare G6 HCP site -provider.dexcom.com/medicare Prescribe Dexcom G6 CGM Prescribe Medicare Powerful glucose insights for better diabetes management Proven clinical outcomes Easy to use1 Covered by Medicare With expanded coverage for CGM, the Dexcom G6 Continuous Glucose Monitoring (CGM) System is accessible for more of your Medicare patients* than ever before. "XgaUkE&*R*j>qQ?Ne3 Z"U^5aNPfbVYIa"x =$;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 To be eligible for ODSP as a person with disability, patients must meet the program Eligibility criteria. What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. Currently, CGM system sensors can be used three (3)-90 days before replacement. You will be going to a new website, operated on behalf of the Blue Cross and Blue Shield Service Benefit Plan by a third party. * Dexcom data on file (commercial insurance plans for T1 and T2 patients taking insulin). *28zVe +2a$ V Where can patients fill their Dexcom G6 scripts? The process for Pacific Blue Cross members to obtain coverage of the Dexcom G6 CGM is changing. 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. and Dexcom CLARITY are registered trademarks of Dexcom, Inc. in the U.S. and may be in other countries. 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. I have used dexcom for over 10 years, dozens of different policies and never denied! When will existing Medicare patients have access to Dexcom G6? information and promotional communications related to Dexcom products. These products are covered by U.S. patent. Prescribers should follow the new patient prescription process. for more information on the Patient Assistance Program. Dexcom G6 supplies will be delivered at no cost to your patient. Learn more. A small, reusable transmitter connects to the sensor and sends real-time readings wirelessly to a receiver, so users can view the information. 3 0 obj BC PharmaCare will not retroactively reimburse patients for benefits purchased before approval of a Special Authority request. Also, many Medicare beneficiaries have secondary insurance that covers their copayment. In fact, Walgreens' Find Care marketplace introduced a program in 2019 in which interested people with diabetes can proactively request a prescription for the Dexcom G6. ' iAGn u)ci` pi{QIZ`e[8q]smU9*2=C%8CJpx Medicare patients currently using Dexcom G5 will be automatically updated to Dexcom G6 when their G5 transmitter is out of warranty. Also, many Medicare beneficiaries have secondary insurance that covers their copayment. 2019;6. The Dexcom G6 is covered by BC PharmaCare. For a complete description of Medicare coverage criteriavisit theCenters for Medicare and Medicaid services website. Customer Service: 1-844-832-1810 Mon-Fri 9am-8pm EST. <>/Metadata 327 0 R/ViewerPreferences 328 0 R>> For a complete description of Medicare coverage criteriaand additional information related to what should be included in the chart notes, please visit the Centers for Medicare and Medicaid services website. Anyone else experiencing this?? endobj 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. A patient must call their plan to confirm that the distributor is in their network. Click here for important updates on coverage and purchase options. 7E^DPN)0>fe E+gM2^6xX3,o):,`5-ihS,3Ei6^.h,.#=DaSv/ee)w(($2HG\Oz~:P+S~XysQ b~\ vT(PAQ{ 4\' @e^NN(eU. 2019;21(3):128-132. The Dexcom G6 is indicated for users aged 2 and older while the Libre 2 is indicated for ages 4 and older. What can I do? Talk to your doctor about which treatments, or combination of treatments, are right for you. The estimated wait time between referral and an assessment appointment may take from 30 to 60 days. 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. Dexcom G4 Platinum A9277 Prior authorization is required. To view a list of compatible smart devices, visit dexcom.com/compatibility. 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. Eligible members* who take steps to keep their A1c levels under control can earn up to $100 on their MyBlue Wellness Card by participating. The initial approval duration is two years. Time in range is a powerful supplement to A1C because it shows a more complete picture of changes in glucose levels. Sugar in the blood comes from the foods that we eat. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. Please review the terms of use and privacy policies of the new site you will be visiting. Contact Dexcom to get the specific information you will need with your insurance plan as plan requirements vary. 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 N?[;IR. Take note of any annual dollar maximums, copays, or deductibles. The ODSP website also contains information on How to apply. The ACSD website also contains information on How to apply. Sign up to receive our monthly email newsletter, tips for healthy living, and important updates. What documents must be provided to my insurance company? 3 0 obj Click here to download a PDF summary of the Ontario ADP coverage information. The Dexcom G6 is now available for patients who meet the Medicare coverage criteria. 2017;167(6):365-374. There is no change for any other CGM or Flash Glucose Monitor (Freestyle Libre or Libre 2) at this time. If you are a Dexcom User or Patient, please contact Dexcom Everyone's health insurance plan is different. Eligible members* can earn up to $100 on their MyBlue Wellness Card by participating in the program. 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. Diabetes Management Incentive Program. 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