1 0 obj 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). 2021;27(6):505-537. 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 People living with diabetes can gain valuable insight about their glucose levels, rate, and direction of change, allowing them to proactively manage their diabetes. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. endobj A Diabetic's Guide: How to Count Carbs Like a Pro. You may have pharmacy coverage for Dexcom through your insurance, which would allow you to get supplies at your local pharmacy. Dexcom G6 is available at the distributors listed below. 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. By continuing to use this website, you consent to these cookies. ( OVtN Most people with type 1 diabetes on commercial health insurance are covered. As far as I understand it, Dexcom is covered by your pharmacy benefit, not through Anthem. 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. 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. Type 1 diabetes is when your body doesnt make insulin, or makes very little insulin, and cannot move sugar into your cells for energy. If rejected, Dexcom will notify the patient of their unsuccessful application and discuss their options moving forward. Through a variety of programs and resources, were committed to helping you manage diabetes and take an active role in your health. All rights reserved. Anyone else experiencing this?? Yes. 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. Everyones health insurance plan is different. 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. 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. 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 . Dexcom has decided to refer all Medicare patients to trusted distributors with experience serving Medicare patients. Pacific Blue Cross supports this change, which will provide British Columbians living with diabetes more options for diabetes management. <>/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>> The initial approval duration is two years. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Check your member profile to see if the Dexcom G6 CGM is a benefit under your Pacific Blue Cross plan. Coverage Information | Blue Cross and Blue Shield of Texas Find Care Shop Plans Prescription Drugs Insurance Basics Member Services Ask Question Request Brochure Request Agent Call Us Please send us your question so a licensed agent can contact you. #1 preferred CGM system 2023 Dexcom Canada, Co. All rights reserved. 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. Phone Check out the changes and updates to our plan in 2023. An adhesive patch holds the sensor in place so the sensor can measure glucose levels in the interstitial fluid. Please use this form to assist in identifying members who meet Blue Cross Blue Shield of Massachusetts' . 1 0 obj Qualified individuals for the ADP funding will receive 100% coverage for their Dexcom G6. We use cookies on this website to give you the best experience and measure website usage. Why is Dexcom referring patients to distributors? 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. 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. 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). endobj 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. If approved, your initial BC PharmaCare Special Authority approval period is valid for one year. 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. <>>> 2019;6. Medicare patients currently using Dexcom G5 will be automatically updated to Dexcom G6 when their G5 transmitter is out of warranty. This means they will automatically get a new Dexcom G6 transmitter and sensors with instructions on how to update the receiver and app. Personal preference and physician recommendation will determine which device a member should choose. The Dexcom G6 is covered by BC PharmaCare. What is Continuous Glucose Monitoring (CGM)? endobj Are you a current customer facing financial constraints? For a complete description of Medicare coverage criteriavisit theCenters for Medicare and Medicaid services website. The estimated wait time between referral and an assessment appointment may take from 30 to 60 days. 0!o!eg[Z'K'xt[ Does this change apply to all CGM devices? 4510 13th Ave. S. * Dexcom data on file (commercial insurance plans for T1 and T2 patients taking insulin). %PDF-1.5 More than 30 million Americans have diabetes. Continuous Glucose Monitoring (CGM) is a method to track glucose levels throughout the day and night. Also, many Medicare beneficiaries have secondary insurance that covers their copayment. 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. Anyone with PharmaCare Special Authority must get their Dexcom G6 supplies from a pharmacy. Step 1: Ask your doctor to e-prescribe your Dexcom CGM supplies to your local pharmacy and to confirm coverage with your pharmacist. Is the Dexcom G6 Medicare copayment more expensive than for that of other CGM brands? When will existing Medicare patients have access to Dexcom G6? 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? 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. 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. *You must be 18 or older on a Standard or Basic Option plan to earn this reward. 4 0 obj CareCentrix is an independent company contracted with Florida Blue to manage durable medical equipment. * The process is simple: below and fill out the form provided. Diabetes Overview - Blue Cross and Blue Shield's Federal Employee Program Diabetes Programs and resources to help you better understand, manage and prevent diabetes. Pacific Blue Cross will align with BC PharmaCares criteria for Dexcom G6 coverage. Follow these two simple steps to get your eligible* Medicare patients quickly started on Dexcom G6. Also, many Medicare beneficiaries have secondary insurance that covers their copayment. Glucose results are used by the individual to closely monitor their glucose levels to help them to better self-manage their diabetes. JAMA. Dexcom G6 supplies will be delivered at no cost to your patient. Reddit and its partners use cookies and similar technologies to provide you with a better experience. 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. What can I do? The process for Pacific Blue Cross members to obtain coverage of the Dexcom G6 CGM is changing. Diabetes Management Incentive Program. Have private insurance coverage for Dexcom supplies? If a Medicare patient is denied coverage for Dexcom G6, it will be the distributors role to advise the patient or provider on the next steps for obtaining coverage. This applies for both new prescriptions and refills. Eligible members* who take steps to keep their A1c levels under control can earn up to $100 on their MyBlue Wellness Card by participating. You can use these rewards to pay for qualified medical . Replacement is not covered due to loss, negligence or improper use. How do I apply for coverage of the Dexcom G6? 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. 2 Seagrove Partners Q1 2021 HCP Perspectives Survey. Thats why its important to know your risk factors for type 2 diabetes and see your doctor regularly for blood glucose tests. View the Preferred Drug List (PDL) 2023 Dexcom, Inc. All rights reserved. Click here to download a printable PDF copy of the ADP Application for Funding Real-Time Continuous Glucose Monitoring System (rtCGM). A customer representative will follow up with you to process a full insurance benefits check after reviewing your information. If a current Dexcom G6 patient ages into Medicare eligibility (i.e., turns 65), they will be treated as a new 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. 6 Grunberger G, et al. //8n,gxdqfc^nNK..R0NUdH>f?YUIOevy_Y_ They told me to pay out of pocket. 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. independently perform fingerstick glucose testing. CGM devices covered by Medicare are defined in CMS Ruling 1682R as For a list of DEP clinics registered with the ADP: https://www.ontario.ca/page/insulin-pumps-and-diabetes-supplies#section-3. By rejecting non-essential cookies, Reddit may still use certain cookies to ensure the proper functionality of our platform. Since A1C is a three-month average, it doesnt give insight into potentially dangerous high and low glucose variations. <> For more information, please see our Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. Yes. Prescribers should follow the new patient prescription process. 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. The patient/family/caregiver agrees to comprehensive and age-appropriate diabetes education by an interdisciplinary diabetes healthcare team and commits to regular follow-up. Blue Cross Blue Shield of Rhode Island maintains the right to audit the services provided to our members, . Where can I get more information or support for my office or my patients? 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 Seek medical advice and attention when appropriate, including for any medical emergency. ' iAGn u)ci` pi{QIZ`e[8q]smU9*2=C%8CJpx Your member ID card is your key to using your medical plan benefits. Privacy Policy. Studies have shown that CGM systems may help reduce A1C levels and reduce hypoglycemia. The existing Detailed Written Order (DWO) will be honored. 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. 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. 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. 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. Receiver is required to be used along with smart device in order to receive Medicare benefits for CGM. Diabetes is more common than you may know. Get a new Dexcom G6 insurance benefits Check after reviewing your information would. 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