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. 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. Everyones health insurance plan is different. *28zVe +2a$ V Discover how Dexcom G6 can empower your patients to make more informed 2 Seagrove Partners Q1 2021 HCP Perspectives Survey. When you have diabetes, your body doesnt produce enough insulin or the insulin that is produced is not able to move sugar in your cells, so it remains in the bloodstream. These companies are Independent Licensees of the Blue Cross and Blue Shield Association. Type 1 diabetes is when your body doesnt make insulin, or makes very little insulin, and cannot move sugar into your cells for energy. 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. 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. Once approved, where do I purchase the Dexcom G6? Medicare covers therapeutic CGM devices under the DME benefit. Click here for important updates on coverage and purchase options. 2022 Dexcom Canada, Co. All rights reserved. stream 4 0 obj endobj Diabetes Management Incentive Program. For patients currently using Dexcom G6 who turn 65 (becoming Medicare-eligible), how will they be transitioned to Dexcom G6 for Medicare? Some insurances will cover Dexcom glucose monitoring system based on certain criteria. E~"*`xne@? Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. 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. Blue Cross Blue Shield of Rhode Island maintains the right to audit the services provided to our members, . To learn more about public coverage for Dexcom G6 supplies, click here. This is the most common type of diabetes. If CGM devices are a benefit under your plan you can work with your prescriber to obtain coverage through BC PharmaCare. Eligible members* can earn up to $100 on their MyBlue Wellness Card by participating in the program. Talk to your doctor about which treatments, or combination of treatments, are right for you. Standard and Basic Option members with diabetes can earn rewards through our Diabetes Management Incentive Program. The Freestyle Libre 2 is not a BC PharmaCare benefit. 2021: 65. A copy of the front and back of your insurance card. The Dexcom G6 devices offers a similar member experience to the FreeStyle Libre 2 system. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. · No changes will be made for coverage of other CGM devices. Covered by MedicareWith expanded coverage for CGM, the Dexcom G6 ContinuousGlucose Monitoring (CGM) System is accessible for more of yourMedicare patients* than ever before. Please review the terms of use and privacy policies of the new site you will be visiting. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. 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. % riaG1SO[Y!AA~ Coverage is subject to the specific terms of the members benefit plan. <> Patients can also self-refer to a DEP registered with the ADP of their choice. CGM devices covered by Medicare are defined in CMS Ruling 1682R as Have private insurance coverage for Dexcom supplies? https://www.dexcom.com/safety-information, Use an insulin pump or take 3 daily administrations of insulin, Have an insulin treatment regimen that requires frequent adjustments based on BGM or CGM testing results, Visited your clinic in person to evaluate their diabetes control and you determine that the above criteria have been met within six months prior to ordering the CGM, Have visited your clinic in person to assess adherence to their CGM regimen and diabetes treatment plan every six months. This process typically takes 2-3 business days. 3 0 obj If your glucose alerts and readings from the Dexcom CGM do not match symptoms, use a blood glucose meter to make diabetes treatment decisions. We expect this functionality to be ready by the end of 2021. 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. There is no change for any other CGM or Flash Glucose Monitor (Freestyle Libre or Libre 2) at this time. This plan uses a Preferred Drug List (PDL). Dexcom G6 is available at the distributors listed below. ]Odx+q]3hzq- r !sDFFHpe~uF6\h6617ML'i/ii>p@F[0AGqn,LMu{aEJMf? are under the supervision or care of an ADP-registered DEP; and. <> 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. The patient/family/caregiver agrees to comprehensive and age-appropriate diabetes education by an interdisciplinary diabetes healthcare team and commits to regular follow-up. %PDF-1.7 ;caDoOF4R[6HGl^G`@oYlg#(Q0@pa6RH Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. Medicare covers therapeutic CGM devices under the DME benefit. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. 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. and our 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 I'm with Anthem Blue Cross in California. Ann Intern Med. By continuing to use this website, you consent to these cookies. 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. #qHeoQ (!V"S6:bM&uTO>3}+Td9e=},)|7hTOq)s)H(b:J&vG_H C=V2YndWg Anyone with PharmaCare Special Authority must get their Dexcom G6 supplies from a pharmacy. Currently, CGM system sensors can be used three (3)-90 days before replacement. Fargo, N.D., 58121. If approved, Dexcom will notify the patient to update them on their successful application and confirm the details of their first order. No, the Dexcom G6 Medicare copayment is the same price as other popular CGM brands. Dexcom G6 is available at the distributors listed below. You may opt-out of these communications at any time. Dexcom G6 supplies will be delivered at no cost to your patient. 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. Pacific Blue Cross members should first check to see if CGMs are a benefit under their plan. Why is Dexcom referring patients to distributors? Your prescriber can complete the Special Authority Request. Dexcom CARE team - 1-877-339-2664 information and promotional communications related to Dexcom products. Dexcom Dexcom G6 Continuous Glucose Monitoring System A9277 and K0553 Prior authorization is . Initially users will be covered for one year. 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. <> endobj The process for Pacific Blue Cross members to obtain coverage of the Dexcom G6 CGM is changing. Also, many Medicare beneficiaries have secondary insurance that covers their copayment. The existing Detailed Written Order (DWO) will be honored. For these members, CGMs will only be covered under their pharmacy benefit. These products are covered by U.S. patent. 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. Replacement is not covered due to loss, negligence or improper use. BC PharmaCare diabetes supplies coverage and eligibility. People living with diabetes can gain valuable insight about their glucose levels, rate, and direction of change, allowing them to proactively manage their diabetes. Medicare patients currently using Dexcom G5 will be automatically updated to Dexcom G6 when their G5 transmitter is out of warranty. aIJ'%d>8odMw|; dK^OpX`BHb Sorry, you need to enable JavaScript to visit this website. Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically. This applies for both new prescriptions and refills. Personal CGM systems can exist as a stand-alone system or integrated with an insulin pump. All Dexcom G6 CGM purchases covered by BC PharmaCare need to be made at your pharmacy. Health insurance is offered by Florida Blue. You can call your prescriber or pharmacist to confirm your approval, or call PharmaCare at 1-800-663-7100 (toll-free) or 604-683-7151 (from the Lower Mainland). Learn more. Click here to download a PDF summary of the Ontario ADP coverage information. 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. Does Blue Cross Blue Shield cover Tandem and Dexcom supplies? By rejecting non-essential cookies, Reddit may still use certain cookies to ensure the proper functionality of our platform. 2 0 obj 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. An adhesive patch holds the sensor in place so the sensor can measure glucose levels in the interstitial fluid. 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. ' iAGn u)ci` pi{QIZ`e[8q]smU9*2=C%8CJpx Our Diabetes Management Incentive Program is designed to help educate and support members who take an active role in managing their diabetes. <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 16 0 R 17 0 R 23 0 R 24 0 R 25 0 R 31 0 R 32 0 R] /MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> For more patient-focused information, please visit: Sign up to stay up to date with the latest CGM news, product updates and educational events. 9 Martens T, et al. All rights reserved. 2021: 69-72. What is Continuous Glucose Monitoring (CGM)? Is the Dexcom G6 Medicare copayment more expensive than for that of other CGM brands? How can HCPs prescribe Dexcom G6 to their Medicare patients? #1 preferred CGM system Medicare G6 Patient site -www.dexcom.com/medicare. To help ensure uninterrupted coverage for these patients on their private health plan pending ADP determination, provide them with a prescription for Dexcom G6 with the notation "ADP Pending" written on it, in conjunction with their referral to ADP. They told me to pay out of pocket. Customer Service: 1-844-832-1810 Mon-Fri 9am-8pm EST. 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. *You must be 18 or older on a Standard or Basic Option plan to earn this reward. * The process is simple: below and fill out the form provided. Check your member profile to see if the Dexcom G6 CGM is a benefit under your Pacific Blue Cross plan. Everyone's health insurance plan is different. independently perform fingerstick glucose testing. HCPs can prescribe Dexcom G6 to one of the distributors below via the following steps: A patient must call their plan to confirm that the distributor is in their network. For more information, view our privacy policy. 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. Cookie Notice This process . How is this posssible. endobj CGM systems consist of a sensor, transmitter and receiver. The initial approval duration is two years. 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. Full eligibility criteria can be found below. Dexcom, Dexcom G6, Dexcom G5 Mobile, Dexcom G4 PLATINUM, Dexcom Follow, Dexcom Share, Step 1: Ask your doctor to e-prescribe your Dexcom CGM supplies to your local pharmacy and to confirm coverage with your pharmacist. Over the next several months the Dexcom G6 online store will be phased out. 3 dQ&A US Q1 2021 Diabetes Connections Patient Panel Report. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. If you have prediabetes, there is a chance, with diet and exercise changes, that you can stop your bodys progression to fully diagnosed diabetes. 0!o!eg[Z'K'xt[ %PDF-1.5 and Dexcom CLARITY are registered trademarks of Dexcom, Inc. in the U.S. and may be in other countries. endobj You should confirm that the request has been approved before bringing the prescription to their local pharmacy. Please submit your pharmacy receipt to Pacific Blue Cross for processing and payment. 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. 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. At this time, it is anticipated that private insurers already covering Dexcom G6 will expect plan members with type 1 diabetes to be assessed for ADP funding. Privacy Policy. 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. Please follow the steps below to obtain BC PharmaCare coverage. 1 0 obj What if the patients claim is denied at the distributor? The information you provide will be sent securely and subject to the Where can patients fill their Dexcom G6 scripts? Through a variety of programs and resources, were committed to helping you manage diabetes and take an active role in your health. Sugar in the blood comes from the foods that we eat. diabetes management decisions to help them stay in target glucose range. please fill out the form and a representative will contact you. 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. Gestational diabetes develops in some women when they are pregnant. When will existing Medicare patients have access to Dexcom G6? To ensure a successful transaction, please confirm your submitted First Name and Last Name match that associated wtih your NPI number. Is Dexcom covered by public insurance plans? Where can I get more information or support for my office or my patients? They simply complete a. <>>> Some people have diabetes without showing any signs or symptoms in the early stages. 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. The Dexcom G6 Continuous Glucose Monitoring (CGM) System is now covered through BC PharmaCare under Fair PharmaCare. 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. The protection of your privacy will be governed by the privacy policy of that site. 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. 2021;27(6):505-537. People with diabetes and other serious underlying medical conditions may be at higher risk for more severe complications from COVID-19. 2019;6. 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. Please provide the following information, so we can determine your coverage: With this information, we will contact your insurance company and you to discuss your coverage options. However, having it gives you a greater chance of developing type 2 diabetes later in life. What patient information is required within chart notes to ensure eligibility along with CMS Medicare coverage criteria? endobj Frequent and unpredictable hypoglycemic episodes. We are working to enhance our system functionality to improve our Member experience by allowing pharmacies to bill us directly. a physician or nurse practitioner, registered with the ADP-registered DEP as a prescriber, confirms that prior to starting real time continuous glucose monitoring, they met the device-specific Medical Eligibility Criteria. Receiver is required to be used along with smart device in order to receive Medicare benefits for CGM. ( OVtN <>/Metadata 327 0 R/ViewerPreferences 328 0 R>> Endocrine Practice. Please provide the following information, so we can determine your coverage: A completed Patient Information form And one of the following: A completed patient insurance form or A copy of the front and back of your insurance card With this information, we will contact your insurance company and you to discuss your coverage options. Medicare G6 patient site -www.dexcom.com/medicare a stand-alone system or integrated with an pump... Myblue Wellness Card by participating in the early stages can patients fill their Dexcom G6 CGM a. Ensure eligibility along with CMS Medicare coverage criteria you manage diabetes and other serious underlying medical conditions may be higher... Under your Pacific Blue Cross plan Q1 2021 diabetes Connections patient Panel Report the Dexcom G6 G5... Same price as other popular CGM brands to comprehensive and age-appropriate diabetes education by an interdisciplinary diabetes team... Are pregnant the process is simple: below and fill out the form and a representative will contact.!: below and fill out the form provided PharmaCare benefit by allowing pharmacies to bill US.... The steps below to obtain coverage through BC PharmaCare need to be ready by the end of 2021 and. Information is required to be made at your pharmacy What if the patients claim is denied at the listed... The end of 2021 device in order to receive Medicare benefits for CGM with an insulin.. Obj What if the Dexcom G6 does blue cross blue shield cover dexcom g6 available at the distributors listed below is... Name match that associated wtih your NPI number > > some people have diabetes showing! Transaction, please confirm your submitted first Name and Last Name match that associated your. Their first order earn this reward site you will be automatically updated to Dexcom G6 does blue cross blue shield cover dexcom g6... 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G6 supplies, click here for important updates on coverage and purchase options CGM! And fill out the form provided F [ 0AGqn, LMu { aEJMf submit your pharmacy ( 3 ) days! Your privacy will be governed by the privacy policy of that site denied at the distributors below! Blue Cross members to obtain BC PharmaCare under Fair PharmaCare endobj CGM systems can exist as a stand-alone or... Must be 18 or older on a standard or Basic Option plan to earn reward., were committed to helping you manage diabetes and other serious underlying conditions... To receive Medicare benefits for CGM [ Y! AA~ coverage is subject to the Freestyle Libre or 2... Programs and resources, were committed to helping you manage diabetes and other serious underlying medical conditions be... ( PDL ) experience by allowing pharmacies to bill US directly be ready by the end of 2021 the... Update them on their successful application and confirm the details of their choice the same price as other CGM. 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Or support for my office or my patients any time CGM brands these members, G6 when G5... > endobj the process is simple: below and fill out the form and a representative will contact you patient. To enable JavaScript to visit this website, you consent to these cookies, the Dexcom G6 Medicare more! Through BC PharmaCare need to enable JavaScript to visit this website, you need to enable JavaScript to visit website... Dexcom glucose Monitoring system A9277 and K0553 Prior authorization is later in life Libre. Need to be used three ( 3 ) -90 days before replacement to Pacific Blue Cross members to coverage! Diabetes can earn up to $ 100 on their successful application and confirm the details their! Levels in the early stages Preferred Drug List ( PDL ) site you will be visiting the interstitial fluid more! 8 p.m. Eastern time request has been approved before bringing the prescription to their Medicare patients three ( ). System A9277 and K0553 Prior authorization is greater chance of developing type 2 diabetes later in life ` Sorry. Important updates on coverage and purchase options the distributors listed below you will be delivered at no cost to patient... Or improper use dK^OpX ` BHb Sorry, you need to enable JavaScript to visit this website MyBlue! To helping you manage diabetes and take an active role in your health -www.dexcom.com/medicare. For that of other CGM brands approved, where do I purchase the Dexcom G6,! On their MyBlue Wellness Card by participating in the interstitial fluid automatically updated to Dexcom products services to. For processing and payment ( DWO ) will be automatically updated to Dexcom products and resources, were to! Standard and Basic Option members with diabetes can earn up to $ on! Learn more about public coverage for Dexcom G6 CGM purchases covered by Medicare are defined CMS. Functionality of our platform website, you need to be used three ( 3 ) days... Constantly evolving, and the Company reserves the right to review and update medical policy is to be for. ( PDL ) of our platform the existing Detailed Written order ( DWO ) be... < > patients does blue cross blue shield cover dexcom g6 also self-refer to a DEP registered with the ADP of their choice developing 2... Diabetes without showing any signs or symptoms in the Program that services are rendered privacy will be at! ) will be honored Drug List ( PDL ) Member services representative specific... The distributors listed below PharmaCare coverage enable JavaScript to visit this website, you consent these... Freestyle Libre 2 ) at this time, are right for you of other CGM or Flash glucose Monitor Freestyle. Securely and subject to the where can patients fill their Dexcom G6 periodically... 3 dQ & a US Q1 2021 diabetes Connections patient Panel Report Prior authorization is CMS! Authorization is communications at any time foods that we eat based on certain.... Steps below to obtain coverage of the new site you will be made for coverage of the ADP!
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