For patients currently using Dexcom G6 who turn 65 (becoming Medicare-eligible), how will they be transitioned to Dexcom G6 for Medicare? You can use these rewards to pay for qualified medical . 2021: 65. Reddit and its partners use cookies and similar technologies to provide you with a better experience. #qHeoQ (!V"S6:bM&uTO>3}+Td9e=},)|7hTOq)s)H(b:J&vG_H C=V2YndWg Health insurance is offered by Florida Blue. As such, we will be matching coverage criteria for the Dexcom G6 CGM for our Members. and our window.__mirage2 = {petok:"1HofDHLtMxUU5p5OUOWGr1uLsA_KL6zgddtQxlS.9Sg-1800-0"}; 1 0 obj Seek medical advice and attention when appropriate, including for any medical emergency. [CDATA[ <>/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>> #1 preferred CGM system The Dexcom G6 is indicated for users aged 2 and older while the Libre 2 is indicated for ages 4 and older. Are you a current customer facing financial constraints? LBL017668 Rev004 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. 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. Customer Service: 1-844-832-1810 Mon-Fri 9am-8pm EST. %PDF-1.7 Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Your prescriber can complete the Special Authority Request. endobj &y/Brb4L xDAs?3t%Nufg|{CRt-Jm6lN(+/.}NX[oP4i*V }"WI"+i\mQb}d*W.i}H I have used dexcom for over 10 years, dozens of different policies and never denied! You should confirm that the request has been approved before bringing the prescription to their local pharmacy. Everyones health insurance plan is different. 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. 2021;27(6):505-537. Replacement is not covered due to loss, negligence or improper use. Dexcom G6 Continuous Glucose Monitoring System (Dexcom) in 2018 and is indicated for the . CGM systems consist of a sensor, transmitter and receiver. <> Where can I get more information or support for my office or my patients? 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. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. the privacy and confidentiality of your personal information. Diabetes Management Incentive Program. Over time, diabetes can increase your risk for serious health conditions, including heart disease, blindness, kidney failure and even amputations. All Dexcom G6 CGM purchases covered by BC PharmaCare need to be made at your pharmacy. Take note of any annual dollar maximums, copays, or deductibles. stream Error: Please enter a valid email address. To be eligible for ODSP as a person with disability, patients must meet the program Eligibility criteria. Pacific Blue Cross will align coverage duration with PharmaCare. How is this posssible. Follow these two simple steps to get your eligible* Medicare patients quickly started on Dexcom G6. Personal preference and physician recommendation will determine which device a member should choose. 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. The information you provide will be sent securely and subject to the Through a variety of programs and resources, were committed to helping you manage diabetes and take an active role in your health. 8 Welsh JB, et al. 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. Learn more. 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. Sign up to receive our monthly email newsletter, tips for healthy living, and important updates. CGM systems consist of a sensor, transmitter and receiver. NOTE:Upgrade to or replacement of an existing CGM is considered not medically necessary when requested for convenience or simply to upgrade to a newer technology, when the current components remain functional, or when the current components remain under warranty. 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. Dexcom CARE team - 1-877-339-2664 Prediabetes occurs when someones blood sugar levels are higher than normal but not high enough to be classified as diabetes. 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 A copy of the front and back of your insurance card. 2 0 obj EN Canada Language English franais Change Country. % riaG1SO[Y!AA~ Diabetes Overview - Blue Cross and Blue Shield's Federal Employee Program Diabetes Programs and resources to help you better understand, manage and prevent diabetes. If a current Dexcom G6 patient ages into Medicare eligibility (i.e., turns 65), they will be treated as a new patient. 4 0 obj You will no longer need to complete the Pacific Blue Cross prior authorization form. 2019;6. Diabetes occurs when your body is unable to use sugar in the blood. Dexcom G6 Mobile CGM (Dexcom) was approved in 2018 and is indicated for the management of . · Have private insurance coverage for Dexcom supplies? Standard and Basic Option members with diabetes can earn rewards through our Diabetes Management Incentive Program. Internal Medical Policy Committee 3-16-2020 removed invalid diagnosis codes, Internal Medical Policy Committee 7-22-2020 removed Eversense CGM experimental/investigational statement, updated description, added additional diagnosis codes: E11.10, E11.11, E11.8 and E11.9 and added "Billed with Z79.4" to covered diagnosis codes section, Internal Medical Policy Committee 7-22-2021 Added diagnosis code Z96.41, Internal Medical Policy Committee 3-23-2022 Added new codes A4238 and E2102 to the policy effective 4-1-2022, Internal Medical Policy Committee 7-21-2022 Added new codes, G0308 and G0309, to the policy effective 7-1-2022, Fargo (Headquarters) Dexcom G5 Mobile App Android Devices Only, Dexcom G5 Mobile App Apple Devices Only. Dexcom Dexcom G5 Mobile CGM A9277 and K0553 Prior authorization is required. 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. aIJ'%d>8odMw|; dK^OpX`BHb No, the Dexcom G6 Medicare copayment is the same price as other popular CGM brands. This change applies only to the Dexcom G6 CGM. Pacific Blue Cross will align with BC PharmaCares criteria for Dexcom G6 coverage. 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. Medicare covers therapeutic CGM devices under the DME benefit. Anyone else experiencing this?? The PharmaCare Special Authority form will be the only one required to obtain coverage from Pacific Blue Cross. Heres everything you need to know about it. Full list of Medicare coverage criteria see the applicable coverage policy. We use cookies on this website to give you the best experience and measure website usage. Dexcom G4 Platinum A9277 Prior authorization is required. Ann Intern Med. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. ;caDoOF4R[6HGl^G`@oYlg#(Q0@pa6RH Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. 0!o!eg[Z'K'xt[ 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). This is also called blood glucose. <> Individual private insurance plans may differ and are subject to change. 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. We expect this functionality to be ready by the end of 2021. What documents must be provided to my insurance company? No changes will be made for coverage of other CGM devices. Does Pacific Blue Cross provide CGM coverage? The easiest indication for Dexcom G6 or Dexcom G7 coverage by insurance is insulin use. Pacific Blue Cross members must now apply to PharmaCare for Dexcom G6 CGM coverage. 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. Everyone's health insurance plan is different. 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. 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. Most of the time, it goes away after your baby is born. This applies for both new prescriptions and refills. 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. Once approved, where do I purchase the Dexcom G6? please fill out the form and a representative will contact you. First Name* Last Name* Phone* Email Address* How would you prefer to be contacted? 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. Since A1C is a three-month average, it doesnt give insight into potentially dangerous high and low glucose variations. HMO coverage is offered by. Currently, CGM system sensors can be used 3-90 days before replacement. 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. Prescribers should follow the new patient prescription process. <>/Metadata 327 0 R/ViewerPreferences 328 0 R>> Coverage is subject to the specific terms of the members benefit plan. 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 process typically takes 2-3 business days. There is no change for any other CGM or Flash Glucose Monitor (Freestyle Libre or Libre 2) at this time. Dexcom will also provide one (1) Dexcom G6 Receiver at no cost to each approved patient who does not have a compatible smart device. Programs and resources to help you better understand, manage and prevent 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. With expanded coverage for CGM, the Dexcom G6 Continuous, Glucose Monitoring (CGM) System is accessible for more of your. After that, it may be renewed for five years. 2021: 69-72. JAMA. permission to process your personal information to send you additional Please submit your pharmacy receipt to Pacific Blue Cross for processing and payment. CGM systems consist of a sensor, transmitter and receiver. Medicare G6 Patient site -www.dexcom.com/medicare. 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. 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. Why is Dexcom referring patients to distributors? To view a list of compatible smart devices, visit dexcom.com/compatibility. While there is no cure for diabetes, it can be managed. Talk to your doctor about which treatments, or combination of treatments, are right for you. // > coverage subject! 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