Is Dexcom Covered By Medicare

Costs Before And After Coverage

Before the Medicare coverage, âa typical patient would spend $2500 to $4000 a year,â Sayer says. That includes the cost for the transmitter, about $800 to $1000 a year, and sensors.

Dexcomâs G5 Mobile has an externally worn glucose sensor that measures blood sugar levels continuously. It displays the values every five minutes. A small, flexible metal wire or sensor is inserted just below the skin, generating a small electrical signal in response to the amount of sugar there. The signal is converted to a glucose reading.

About 98% of commercial payers have coverage for CGM, Sayer says. Patients typically pay a copay of about 20%, he says.

The turning point for the Medicare coverage, he says, came with the FDA approved label change allowing consumers to make dosing decisions based on the therapeutic testing results with the CGM.

For the older adult population, Sayer says, âthe sensor is giving you a tool that the body loses. Your body loses the ability to detect the low , some more than others.â

Is Dexcom Covered By Medicare

• The patient has diabetes
• The patient is insulin-treated with three or more daily administrations of insulin or a continuous subcutaneous insulin infusion pump
• The patient’s insulin treatment regimen requires frequent adjustments based on BGM or CGM testing results
• Within six months prior to ordering the CGM, the patient had an in-person visit with the treating practitioner to evaluate their diabetes control and determine that the above criteria have been met and
• Every six months following the initial prescription of the CGM, the patient has an in-person visit with the treating practitioner to assess adherence to their CGM regimen and diabetes treatment plan.

• Ask your doctor to prescribe to your chosen Walgreens
• Take your red, white, and blue Medicare card as well as any supplemental coverage cards to Walgreens to ensure you only owe your copay
• Pick up your Dexcom G6 System Continue visiting Walgreens to pick up your Dexcom G6 ongoing supplies.

• A patient uses both a receiver and a smartphone throughout the day
• A patient uses a receiver some days of the week and their smartphone other days of the week

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Dexcom G6 Continuous Glucose Monitoring System Will Be Available To Medicare Beneficiaries With Diabetes In Early 2019

CMS approves coverage for Dexcom G6 CGM, the only CGM system recognized by Medicare that offers mobile device compatibility and no fingerstick calibration

SAN DIEGOâ-DexCom, Inc. , a leader in continuous glucose monitoring , announced today the new Dexcom G6® CGM System will be covered for Medicare beneficiaries, having met the category requirements for therapeutic CGM systems by the U.S. Centers for Medicare & Medicaid Services . Coverage for therapeutic CGM includes certain beneficiaries who have either Type 1 or Type 2 diabetes and intensively manage their insulin. The company expects to begin shipping product to Medicare customers in the first part of 2019.

The Dexcom G6 is a game-changer for people with diabetes, and we are thrilled to provide this innovative technology to the many Americans with diabetes who rely on Medicare, said Kevin Sayer, President and CEO of Dexcom. With the CMS policy coverage, Medicare beneficiaries with diabetes who use G6 will no longer require fingersticks to make treatment decisions or calibrate their CGM.

The new Dexcom G6 boasts a number of features that make it a very powerful diabetes management tool.

Who is covered?

According to CMS, therapeutic CGM may be covered by Medicare when all of the following criteria are met:

How to get the Dexcom G6? Its easy.

About CGM

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Medicare Eligibility For A Therapeutic Cgm

A therapeutic CGM is a medical device approved by the U.S. Food and Drug Administration as a replacement for home blood sugar monitors. It provides you and your doctor with the medically necessary information to make diabetes treatment decisions, such as changes in diet and your insulin dosage.

To qualify for a therapeutic CGM, you must be undergoing treatment for diabetes and meet certain other criteria.

To be eligible for a therapeutic CGM under Medicare, you must meet the following requirements.

• You are using insulin to treat Type 1 or Type 2 diabetes.
• You need to check your blood sugar four or more times per day.
• You must use an insulin pump or receive three or more insulin injections per day.
• You must make routine, in-person visits to your doctor.
• Your doctor has determined that you meet all Medicare eligibility requirements.

The decision between a therapeutic CGM or a traditional monitor is one you should make after talking to your doctor. A therapeutic CGM may be a better option if you use insulin and frequently change your dosage.

Medicare Now Covers Continuous Glucose Monitors

Medicare now covers Continuous Glucose Monitoring Devices such as Abbotts Freestyle Libre® and the Dexcom G6®. These products have revolutionized the way in which our Medicare patients, who test four times per day or more using blood glucose testers and insulin administering, manage their diabetes.

Medicare Covered CGMs

Continuous Glucose Monitoring coverage for Medicare beneficiaries is easy to establish. If you are a Medicare beneficiary, your doctor has prescribed you to test your blood sugar at least four times per day, you are injecting insulin and you are following your prescribers orders you likely qualify for a Continuous Glucose Monitor. We will work with you and your prescriber throughout the process to gather Medicares required documentation. We ensure that you are adequately trained on your new system, and once you initiate your new and revolutionary CGM, you will experience zero interruptions in therapy.

The Abbott Freestyle Libre® is a system that our Medicare beneficiaries prefer as it is easy to adapt to when transitioning from a glucometer to Continuous Glucose Monitoring. The Freestyle Libre for Medicare beneficiaries is a two component system, with a 14 day sensor and with compliant documentation is available for order on a 90 day supply.

Our team is ready to patiently review all of the details regarding these systems and your coverage. Please call and we will gladly answer any questions you have about CGMs and Medicare coverage requirements.

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How Does The Dexcom G6 Work

The G6 measures your blood glucose levels without requiring that painful fingerprick. Instead, a water-resistant sensor is inserted below the skin of the torso where it can measure blood glucose levels in your interstitial fluid. The glucose data is then transmitted to a reader or smart device, such as an iPhone or Android, in real-time so you can read the data and share it whenever you choose.

The Dexcom G6 also brings advantages previously not available for the Dexcom G5. These include:

• Compatibility with a variety of devices.
• Factory calibration.
• A one-touch applicator.
• A low-profile design.
• A torso sensor that you can wear for up to ten days for consistent blood sugar readings.
• The ability to wear the sensor while showering or exercising.
• An acetaminophen-blocking feature designed for those who take acetaminophen frequently and dont want to risk skewing results.
• An Urgent Low Soon alert feature that can alert you before a hypoglycemia event.

Cgm Coverage If You Have Medicaid

Although its great that most private insurance plans and Medicare now covers CGM for more people living with insulin-dependent diabetes, unfortunately, Medicaid coverage is a bit more sporadic.

Medicaid is the single largest source of health coverage in the United States, providing health insurance to more than 80 million Americans.

Medicaid overage differs greatly from state to state which makes it harder to figure out if youre covered, and unfortunately many states do not cover CGMs in their Medicaid programs.

Anyone living with diabetes under the age of 21 on any Medicaid program qualifies for a CGM, but for anyone older than 21, it becomes a bit more complicated.

20 states currently have fairly comprehensive Medicaid coverage of CGM for people living with any type of diabetes, whereas 22 states only have coverage for people living with type 1 diabetes and 7 states have no published coverage.

Who qualifies also differs from state to state with most states requiring prior authorization from a doctor, but youll have to check with your states Medicaid program for specific eligibility criteria, or reach out to a distributor such as US MED.

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Which Cgm Devices Are Covered By Medicare

The Dexcom G5 was one of the first of the CGM devices to be FDA approved as a therapeutic CGM in 2017, which qualified the device for Medicare coverage. As with most other technology, diabetes technology continues to evolve, and newer products have since followed suit, including those manufactured by Abbott, Medtronic, and others.

Currently, Aeroflow offers the Dexcom G6, the FreeStyle Libre 14 Day System and the FreeStyle Libre 2, all eligible for Medicare coverage. The Dexcom devices are typically worn on the skin of the torso for up to 10 days, where a water resistant sensor can measure and transmit blood glucose readings every few minutes to a reader or a smartphone app. The FreeStyle Libre is a line of continuous glucose monitors that are typically worn on the skin of the upper arm for up to 14 days. Unlike the Dexcom, the FreeStyle is a flash glucose monitoring system, meaning that while it continually measures blood glucose levels, it only transmits this to a reader when scanned. Each has its own set of unique features, alarms, and recommended age range.

Patients Can Now Obtain The Dexcom G6 Cgm System At Any Of Walgreens More Than 9200 Retail Pharmacy Locations

About CGM and the Medicare Coverage Criteria

• The beneficiary has diabetes mellitus and,
• The beneficiary has been using a home blood glucose monitor and performing frequent BGM testing and,
• The beneficiary is insulin-treated with multiple daily injections of insulin or a continuous subcutaneous insulin infusion pump and,
• The beneficiarys insulin treatment regimen requires frequent adjustment by the beneficiary on the basis of therapeutic CGM testing results and,
• In six months prior to ordering the CGM, the beneficiary had an in-person visit with the treating practitioner to evaluate their diabetes control and determine that the above criteria are met and,
• Every six months following the initial prescription of the CGM, the beneficiary has an in-person visit with the treating practitioner to assess adherence to their CGM regimen and diabetes treatment plan.

About Walgreens

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Which Is Better Dexcom G6 Or Freestyle Libre

FreeStyle Libre still requires manual analysis to show a real-time glucose reading as the G6 sends data directly to the receiver / app via Bluetooth. For people with hypoglycemia, G6 may be a better choice. For those who want a simpler or longer dress system, FreeStyle Libre 14day may be preferable.

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Medicare Now Allows Cgm Use With Smartphone Apps Including Sharing Features

After over a year of continued advocacy, Medicare will cover mobile CGM use and sharing Medicares policy will be updated by June 21, if not earlier

Medicare beneficiaries can now use continuous glucose monitors with approved smartphone apps, such as Dexcoms G5 mobile app! The news represents a major win after 15 months of advocacy to overturn Medicares much-criticized policy not to allow use of CGM with smartphone apps. According to Dexcom, the deadline for the Centers for Medicare and Medicaid Services to update the coverage policy is June 21, if not sooner.

Current G5 users on Medicare do not have to purchase a new receiver or transmitter to use the G5 app to view their CGM data and share it with loved ones they simply need to download the free G5 app and login with their Dexcom account. The G5 app can be found here for Apple devices and here for Android devices. We recommend waiting until June 21 to do so.

Like other users, G5 Medicare beneficiaries can now choose to view real-time glucose data on the G5 app only, the receiver only, or both devices. New Medicare users will still have to purchase a G5 receiver.

Both Medtronics Guardian Connect and Senseonics Eversense CGMs will not be covered by Medicare until they obtain updated FDA labeling .

It is unclear yet whether this coverage decision will extend to using CGM with connected insulin pumps, such as the t:slim X2, which displays G5 CGM data.

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Medicare Criteria For Therapeutic Cgms*

• The beneficiary has diabetes mellitus
• The beneficiary administers insulin three or more times per day via MDI or inhalation or uses an insulin pump
• The treatment regimen requires the beneficiary to frequently adjust based on the therapeutic CGM testing results
• The beneficiary has seen his/her doctor in the last six months

To remain eligible, the beneficiary must see his/her doctor every six months to evaluate the CGM therapy.

Do you qualify? Apply for your CGM Today! Not sure if you qualify, no problem let our team of diabetes care experts assist you through the process.

* as of July 18, 2021

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New Medicare Coverage Requirements Make Cgms More Accessible

The diabetes community is celebrating a huge win! Beginning on July 18, 2021, Medicare will permanently eliminate the requirement of the four-time-daily fingerstick in order to qualify for coverage of a continuous glucose monitor .

This requirement was an unnecessary barrier for Medicare beneficiaries, delaying access to this effective technology for individuals with diabetes.

CGMs provide users with real-time, dynamic information about their blood glucose levels around the clock and alerts to prevent dangerous high or low glucose levels, leading to better diabetes management and ultimately improved health outcomes. One out of five people on Medicare have diabetes, and the elimination of the fingerstick requirement means Medicare beneficiaries with diabetes will have easier access to this critical technology.

What does this mean for you? If you already have coverage for your CGM, great! If youre looking to get one and receive your health insurance through Medicare, after July 18 there will be a simplified, fingerstick-free approval process. The out-of-pocket cost for your CGM will depend on a few factors, like what your Medicare benefit plan looks like, where youll get your device, etc. Talk to your doctor and a Medicare representative to determine what it will cost for you.

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What Is Freestyle Libre

FreeStyle Libre is a continuous glucose monitoring system that allows a person to check their blood sugar in real-time without having to prick their finger.

The system has two components: a glucose sensor that the person applies to the skin and a digital reader. A person can apply the sensor to the back of their upper arm and leave it in place for a maximum of 14 days.

The sensor monitors a persons blood glucose by measuring glucose levels in the interstitial fluid, which is the fluid between the cells and the blood vessels. A person can hold the digital reader over the sensor to obtain a blood glucose reading.

What About Medicare Coverage For Those Not On Intensive Insulin Therapy

At this time, Medicare coverage is only available to those that meet the criteria above. We feel very strongly that others at risk of hypoglycemia, especially those on sulfonylureas , should also have access to CGM. We will be working on advocacy on this front if youd like to help.

If you have other questions on Abbotts FreeStyle Libre, Dexcoms G5, and Medicare coverage,

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Why Is A Cgm Better Than Regular Glucose Monitoring

Traditional glucose monitoring is based on a fingerstick that reveals your glucose level at that moment. CGMs deliver glucose readings all day and night, which makes it easy to see glucose levels anytime, and to track changes over time, including the time spent in your target range. The information provided by a CGM can help people with diabetes make informed decisions about food, activity, and medication. In addition, CGMs do not require sticking your finger. They are easy to wear and use.

Some CGMs have the added benefit of alarms and alerts which makes it easier for parents and caregivers to monitor a child with diabetes while they are asleep, at school, or away from home.

What Parts Of Medicare Cover Diabetes

The federally funded health insurance program called Medicare includes:

• Part A, which offers hospital insurance coverage
• Part B, which provides coverage for medical insurance
• Part C, also known as Medicare Advantage, which offers an alternative to original Medicare
• Part D, which offers prescription drug coverage

Medicare considers designated blood glucose monitoring systems, such as FreeStyle Libre, to be durable medical equipment . Therefore, Medicare Part B will help pay for a portion of the costs.

However, some qualifying requirements apply, including:

• A doctor must certify that the monitor is medically necessary and prescribe it.
• Both the prescribing physician and the supplier must accept Medicare assignment.
• A person must test their blood sugar levels at least four times a day and use insulin injections at least three times daily.

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Does Medicare Pay For Continuous Glucose Monitor

Medicare covers therapeutic continuous glucose monitors and related supplies instead of blood sugar monitors for making diabetes treatment decisions, like changes in diet and insulin dosage.

Which insurance covers dexcom?

In January, there was a small breakthrough: Medicare announced it would cover Dexcoms G5 Mobile CGM as durable medical equipment, making it easier for recipients with all types of diabetes to get coverage.

Does Medicare Cover Diabetes Shoes

Medicare pays for therapeutic shoes and inserts when necessary. Patients often need shoes because diabetes takes a toll on the feet and circulation. Medicare pays for the shoes when a qualifying doctor prescribes diabetic shoes.

However, compression stockings dont receive Medicare coverage.

Medicare pays for one of the following each year:

• One pair of depth-inlay shoes + 3 pairs of shoe inserts
• One pair of custom-molded shoe
• patients that are unable to wear the custom shoes because of a foot deformity may substitute for two extra shoe inserts

Some instances allow Medicare to cover separate shoe adjustments instead. When your treating doctor certifies that you meet the three following conditions, Medicare will pay for your therapeutic shoes.

You must have one of the following in one foot or both:

• Partial or complete foot amputation
• History of foot ulcers

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