The ACSD website also contains information on How to apply. 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. Time in range is a powerful supplement to A1C because it shows a more complete picture of changes in glucose levels. 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. 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. 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. Does this change apply to all CGM devices? 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]. %PDF-1.7 The Freestyle Libre 2 is not a BC PharmaCare benefit. Cookie Notice All rights reserved. 2019;21(3):128-132. #1 preferred CGM system <>/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>> Dexcom G6 supplies will be delivered at no cost to your patient. *You must be 18 or older on a Standard or Basic Option plan to earn this reward. 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. If you could not find answers to your questions, contact us directly for help. 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. 2 Seagrove Partners Q1 2021 HCP Perspectives Survey. The Dexcom G6 CGM is now covered through BC PharmaCare under Fair PharmaCare, Plan C (Income Assistance), Plan F (At Home Program), or Plan W (First Nations Health Benefit). Studies have shown that CGM systems may help reduce A1C levels and reduce hypoglycemia. What is Continuous Glucose Monitoring (CGM)? The process for Pacific Blue Cross members to obtain coverage of the Dexcom G6 CGM is changing. Medicare G6 HCP site -provider.dexcom.com/medicare CGM systems consist of a sensor, transmitter and receiver. x=n>8n,gxdqfc^nNK..R0NUdH>f?YUIOevy_Y_ endobj Is Dexcom covered by public insurance plans? Customer Service: 1-844-832-1810 Mon-Fri 9am-8pm EST. 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. * The process is simple: below and fill out the form provided. Medicare patients currently using Dexcom G5 will be automatically updated to Dexcom G6 when their G5 transmitter is out of warranty. endobj How is this posssible. Frequent and unpredictable hypoglycemic episodes. 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 . Replacement is not covered due to loss, negligence or improper use. If they do not have a compatible receiver, they will get a new Dexcom G6 receiver. 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. First Name* Last Name* Phone* Email Address* How would you prefer to be contacted? The Dexcom G6 is indicated for users aged 2 and older while the Libre 2 is indicated for ages 4 and older. A CGM system may be considered medically necessary whenONEof the following criteria are met: All other uses for CGM systems are considered experimental/investigational and therefore, non-covered because their safety and/or effectiveness cannot be established by the review of the published peer-reviewed literature. These products are covered by U.S. patent. Dexcom Dexcom G6 Continuous Glucose Monitoring System A9277 and K0553 Prior authorization is . 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. * The process is simple: Click the link below and fill out the form provided. 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. Click here to download a printable PDF copy of the ADP Application for Funding Real-Time Continuous Glucose Monitoring System (rtCGM). 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. Requires multiple daily injections of insulin or insulin pump therapy as part of intensive insulin therapy. window.__mirage2 = {petok:"1HofDHLtMxUU5p5OUOWGr1uLsA_KL6zgddtQxlS.9Sg-1800-0"}; With the Dexcom G6 System, your current glucose data can be shown on a compatible smart device using the Dexcom G6 App, or on an optional receiver. Dexcom will submit the completed form to ADP on your patients behalf. Learn more here. Sorry, you need to enable JavaScript to visit this website. Step 1: Ask your doctor to e-prescribe your Dexcom CGM supplies to your local pharmacy and to confirm coverage with your pharmacist. Why is Dexcom referring patients to distributors? 3 yr. ago. 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. EN Canada Language English franais Change Country. Prediabetes occurs when someones blood sugar levels are higher than normal but not high enough to be classified as diabetes. 1 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. [CDATA[ This is the most common type of diabetes. Phone If approved, Dexcom will notify the patient to update them on their successful application and confirm the details of their first order. Once approved, where do I purchase the Dexcom G6? 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. Sugar in the blood comes from the foods that we eat. 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. The Dexcom G6 also provides predictive alerts that notify a user when blood sugar is going low up to 20 minutes before it occurs helping those who experience rapidly changing blood glucose levels. HMO coverage is offered by. please fill out the form and a representative will contact you. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. You may have pharmacy coverage for Dexcom through your insurance, which would allow you to get supplies at your local pharmacy. T2/2000/Tresiba,Ozempic,Metformin/Dex G6. Medicare G6 Patient site -www.dexcom.com/medicare. permission to process your personal information to send you additional Most people with type 1 diabetes on commercial health insurance are covered. Error: Please enter a valid email address. 2023 Dexcom Canada, Co. All rights reserved. Glucose results are used by the individual to closely monitor their glucose levels to help them to better self-manage their diabetes. This applies for both new prescriptions and refills. 2 0 obj I live outside of BC. 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. Everyones health insurance plan is different. 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. Click here for important updates on coverage and purchase options. 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. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. 2021: 65. 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. Dexcom G6 is available at the distributors listed below. Pacific Blue Cross will align coverage duration with PharmaCare. Also, many Medicare beneficiaries have secondary insurance that covers their copayment. Florida Blue HMO, an afliate of Florida Blue. More than 30 million Americans have diabetes. Full eligibility criteria can be found below. There is no change for any other CGM or Flash Glucose Monitor (Freestyle Libre or Libre 2) at this time. Health insurance is offered by Florida Blue. Qualified individuals for the ADP funding will receive 100% coverage for their Dexcom G6. *Medicare covers Dexcom G6 for insulin-requiring patients who meet the Medicare coverage criteria. Medicare covers therapeutic CGM devices under the DME benefit. 2 0 obj WTF!!!! 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 The ODSP website also contains information on How to apply. CGM devices covered by Medicare are defined in CMS Ruling 1682R as * Dexcom data on file (commercial insurance plans for T1 and T2 patients taking insulin). Glucose results are used by the individual to closely monitor their glucose levels to help them to better self-manage their diabetes. endobj All Dexcom G6 CGM purchases covered by BC PharmaCare need to be made at your pharmacy. So apparently under NC's State Health Plan (BCBS) CGM supplies are no longer covered. Endocrine Practice. To learn more about public coverage for Dexcom G6 supplies, click here. After that, it may be renewed for five years. endobj For more information, please see our % the privacy and confidentiality of your personal information. If you are a healthcare provider and want to learn more about Dexcom, Your prescriber can complete the Special Authority Request. stream You should confirm that the request has been approved before bringing the prescription to their local pharmacy. 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. 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. Through a variety of programs and resources, were committed to helping you manage diabetes and take an active role in your health. These companies are Independent Licensees of the Blue Cross and Blue Shield Association. 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. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> An adhesive patch holds the sensor in place so the sensor can measure glucose levels in the interstitial fluid. As such, we will be matching coverage criteria for the Dexcom G6 CGM for our Members. If a member receives coverage through BC PharmaCare, Pacific Blue Cross will coordinate that coverage. 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 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). By choosing to request info, you are granting Dexcom, Inc. 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). How long will I be covered for the Dexcom G6? 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. ?;E%}p}o]>H7 {"/:|Y }=l~Tx~dEW%[A+ |)Z9D%SE WW@Y\j7+nH! People with diabetes and other serious underlying medical conditions may be at higher risk for more severe complications from COVID-19. 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. For patients currently using Dexcom G6 who turn 65 (becoming Medicare-eligible), how will they be transitioned to Dexcom G6 for Medicare? Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. The patient/family/caregiver agrees to comprehensive and age-appropriate diabetes education by an interdisciplinary diabetes healthcare team and commits to regular follow-up. How can HCPs prescribe Dexcom G6 to their Medicare patients? 2017;167(6):365-374. This means they will automatically get a new Dexcom G6 transmitter and sensors with instructions on how to update the receiver and app. 5 Centers for Medicare & Medicaid Services, Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs. Dexcom G6 is available at the distributors listed below. Have private insurance coverage for Dexcom supplies? Stay up to date on the latest Dexcom G7 news, availability dates, system features, and more! Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. CGM devices covered by Medicare are defined in CMS Ruling 1682R as 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. By continuing to use this website, you consent to these cookies. 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. 2023 Dexcom, Inc. All rights reserved. Dexcom G4 Platinum A9277 Prior authorization is required. If you have prediabetes, there is a chance, with diet and exercise changes, that you can stop your bodys progression to fully diagnosed diabetes. 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. 2019;6. Over time, diabetes can increase your risk for serious health conditions, including heart disease, blindness, kidney failure and even amputations. Dexcom Dexcom G5 Mobile CGM A9277 and K0553 Prior authorization is required. Also any experience with NC or TN Medicaid and their coverage of CGMs? The Dexcom G6 is now available for patients who meet the Medicare coverage criteria. Prescribers should follow the new patient prescription process. Currently, CGM system sensors can be used 3-90 days before replacement. 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). To view a list of compatible smart devices, visit dexcom.com/compatibility. The information you provide will be sent securely and subject to the How can I receive BC PharmaCare and Pacific Blue Cross coverage? How do I apply for coverage of the Dexcom G6? Has been seen in your clinic within the last 6 months, Uses an insulin pump or takes 3 daily administrations of insulin, Requires frequent adjustments to their insulin treatment regimen based on BGM or CGM testing results, 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, 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 distributors below regarding their Dexcom G6 order. 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. E~"*`xne@? Will PBC be making any system enhancements to better support members? I have used dexcom for over 10 years, dozens of different policies and never denied! 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. If approved, your initial BC PharmaCare Special Authority approval period is valid for one year. When completing the application, it may be necessary to answer No to the questions in section 2a/2b. I'm wondering if those of you who use Blue Cross Blue Shield are able to get Tandem and Dexcom supplies. 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. Diabetes Overview - Blue Cross and Blue Shield's Federal Employee Program Diabetes Programs and resources to help you better understand, manage and prevent diabetes. No, the Dexcom G6 Medicare copayment is the same price as other popular CGM brands. Please use this form to assist in identifying members who meet Blue Cross Blue Shield of Massachusetts' . and Dexcom CLARITY are registered trademarks of Dexcom, Inc. in the U.S. and may be in other countries. 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. Yes. For more patient-focused information, please visit: Sign up to stay up to date with the latest CGM news, product updates and educational events. #qHeoQ (!V"S6:bM&uTO>3}+Td9e=},)|7hTOq)s)H(b:J&vG_H C=V2YndWg A remote interstitial CGM (e.g., mySentry) is considered investigational/experimental and therefore, non-covered because the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature. 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. The PDL is a list showing the drugs that can be covered by the plan. Since A1C is a three-month average, it doesnt give insight into potentially dangerous high and low glucose variations. For more information, view our privacy policy. The PharmaCare Special Authority form will be the only one required to obtain coverage from Pacific Blue Cross. Wednesday, Jul 21, 2021 The Dexcom G6 Continuous Glucose Monitoring (CGM) System is now covered through BC PharmaCare under Fair PharmaCare. If you are a Dexcom User or Patient, please contact Dexcom If rejected, Dexcom will notify the patient of their unsuccessful application and discuss their options moving forward. <> Source:Centers for Disease Control and Prevention (CDC)&American Diabetes Association. stream Dexcom CARE team - 1-877-339-2664 If a current Dexcom G6 patient ages into Medicare eligibility (i.e., turns 65), they will be treated as a new patient. If CGM devices are a benefit under your plan you can work with your prescriber to obtain coverage through BC PharmaCare. Where can I get more information or support for my office or my patients? Check out the changes and updates to our plan in 2023. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. 4 0 obj Initially users will be covered for one year. BC PharmaCare diabetes supplies coverage and eligibility. Currently, CGM system sensors can be used three (3)-90 days before replacement. At least one functional restriction that inhibits the use of blood glucose test strips (BGTS) (e.g., dexterity, mobility, dermatological problems). //
