Monday, November 28, 2022

Is The Dexcom G6 Covered By Medicare

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Why Doctors Are Reluctant To Prescribe Cgm

Dexcom G6 Medicare Patient Coverage

Dexcom execs tell us that 49 percent of doctors say all the insurance red tape currently impacts their willingness to prescribe CGM.

The company believes that more than 50 percent of healthcare professionals would increase the number of prescriptions they write for CGM if it were available across the board as a mainstream pharmacy benefit to all patients.

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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.

Freestyle Libre System Available To Medicare Patients

ABBOTT PARK, Ill. It was just a few months ago that the U.S. Food and Drug Administration approved Abbott Diabetes Cares FreeStyle Libre Flash Glucose Monitoring System for public use in the U.S., making it the first FDA-approved CGM not to require a fingerstick test or manual data entry for calibration. That means that the device is so accurate, people managing Type 1 or Type 2 diabetes can dose insulin off of it.

Today, Abbottannounced that the new, factory-calibrated technology is now available to Medicare patients since its approval by the U.S. Centers for Medicare & Medicaid Services . It will be the only CGM system available to Medicare patients that doesnt require calibration.

At Abbott, we are continuously challenging ourselves to ensure our innovative technology is accessible to the majority of people who need it, said Jared Watkin, Sr. VP at Diabetes Care. This revolutionary health technology is ultimately going to empower Medicare beneficiaries with diabetes to live better, healthier lives.

FreeStyle Libre system reads glucose levels through a sensor that is worn on the back of the upper arm for up to 10 days, making it the longest lasting personal glucose sensor available in the U.S.

Other features include water-resistance and an ability to obtain a reading without the interference of acetaminophen, an active ingredient in many over-the-counter medications, which can inaccurately report dangerously high blood glucose levels.

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Cgm Good Decisions And Good Diabetes Management

Information is power, and thats certainly true for people with diabetes. The more you know about your glucose levels, the better decisions you can make. Talk with your doctor about the benefits of a Continuous Glucose Monitor and find out if this no-stick glucose monitoring method is a good choice for you!

Therapeutic Continuous Glucose Monitors

Dexcom G6® CGM System

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.

If you use insulin and require frequent adjustments to your insulin regimen/dosage, Medicare may cover a continuous glucose monitor if your doctor determines that you meet all of the requirements for Medicare coverage.

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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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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.

How To Use The Dexcom G6 Cgm

Dexcom G6 Dexcom “New Me” Medicare Testimonial

Its easy to use the Dexcom G6. The simple applicator will allow the Dexcom G6 transmitter’s small canula to be inserted under the skin. The needle retracts and the sensor sits on top of the skin and is held in place by adhesive tape. This allows the canula to measure glucose readings in the interstitial fluid, which is fluid that surrounds the cells. The sensor takes glucose readings throughout the day and night and the transmitter allows the sensor to send real-time readings wirelessly to you. You’ll use your monitoring device or an app on your smartphone that to monitor your glucose data.

For more information, visit Dexcom G6 Set Up Guide here. or download the Dexcom G6 Set Up Guide here.

DISCLAIMER: People using products sold by US MED should always refer to the directions provided by a products manufacturer for usage information.

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Ready To Upgrade From The Dexcom G5 To The Dexcom G6

Get started today with the Dexcom G6 a mobile CGM system including customizable alerts that allow you to make more informed decisions about your diabetes management by providing real-time glucose readings sent right to your smart device! Features of the Dexcom G6 System include:

No calibration required No need to calibrate with a blood glucose meter, eliminating the need for fingersticks.

Long-life sensor Approved for up to 10 days of use.

Sensor insertion with auto-applicator Insert the sensor with the push of a button.

Urgent alerts Receive a 20-minute advance warning of a potential severe hypoglycemic event.

Alert schedules Alerts can be customized for two periods of time within 24 hours .

Slim, water-resistant sensor The new, slim sensor is water-resistant and can be submerged under 8 feet of water for up to 24 hours when installed properly.

No fingersticks The Dexcom G6 eliminates fingersticks for calibration and diabetes treatment decisions.

Use the Dexcom Share feature available in the Dexcom G6 CGM app to provide your real-time glucose data with up to 10 followers.

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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Smart Insulin Pens Insulin Pen Needles And Syringes

Devices used to administer insulin– including insulin pens, needles, and syringes – are covered under Medicare Part D for Medicare patients with diabetes. One unique product in this category available from US MED is the InPen, a smart insulin pen that offers personalized recommendations for insulin dosage. Along with that, we carry needles and syringes in various sizes.

What Is The Average Cost Of A Cgm Device

Dexcom G6 CGM Granted Market Authorization

The out of pocket costs of CGM devices can be significant, much more than traditional blood glucose monitoring systems. Depending on what model and features you need, you will have to get prescriptions for several different items and purchase them at a retail pharmacy if you dont have insurance coverage.

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What Does Medicare Cover For Diabetics

If you have diabetes, you know its a day-to-day reality that needs to be attended to. It can feel like a full-time job, but you dont have to do it alone.

Medicare covers various diabetes medications, supplies and services to help treat diabetes and keep your blood glucose in a healthy range.

  • Medicare Part B covers blood glucose testing and other supplies you may need, plus some medical and education services
  • Medicare Part D covers diabetes medications and supplies for injecting or inhaling insulin

Heres a rundown of the diabetes supplies and services that Medicare covers. Some require a prescription or recommendation from your doctor. Coverage limits may include the amount of some supplies you can get or how often some services are covered.

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 DIEGO—-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

About DexCom, Inc.

References

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Medicare And Dexcom G: Yes

There is a lot of discussion on social media this week about Dexcom G6 finally being available for Medicare recipients. Most of it is personal testimony along with a few links and guesses of what the story is. But some seniors are definitely ordering G6 systems and that is great news. I have heard from two sources that Dexcom will be sending current Medicare G5 users A LETTER. But now that the cats out of the bag, many of us are not patiently waiting for instructions from Dexcom.

The most information about G6 Medicare availability is on the Dexcom Provider website. This link details the steps a physician should go through to prescribe a G6 for Medicare patients:

Interestingly Walgreens is being mentioned as the go-to supplier. Walgreens is licensed to dispense Part B DME for Medicare because that is how they have for many years provided test strips, insulin for pumps, and other DME products. Patients are also allowed to use other approved DME suppliers to get their Dexcom G6 and I have chosen to use Solara Medical which provides my pump supplies. Although I am mostly a satisfied Walgreens customer, they do periodically bill my Part B insulin to my Part D prescription plan and I dont want to give them the chance to do the same with my CGM supplies. Hopefully the Dexcom-Walgreens partnership will be successful but I suspect it will take a while to work seamlessly.

Differences In The Two Systems

Dexcom G6 Coverage for Medicare Patients on Mealtime Insulin

Aleppo says that the real-time data from the Dexcom and its alerts of impending problems make it particularly suited to patients whose hypoglycemia unawareness might lead them to manage their fear of hypoglycemia by overeating, taking less insulin, being afraid of exercise, being afraid of driving, and eating unnecessary bedtime snacks to avoid overnight events. Patients sleep better because they know that the alarms can notify them or their companion. For people who have preserved feeling of hypoglycemia, the Freestyle Libre is a great tool convenient and informative. Scanning the flash reader is painless and can be done several times a day. Some patients prefer to be notified about impending hypo- or hyperglycemia, whereas others do not want to hear the alarms.

Ahmann agrees that the Dexcom might be preferred by patients who have hypoglycemic episodes: If you want the most data, you would certainly want the Dexcom platform because it provides more information and has the alarms. The Freestyle Libre is a little simpler for the older patient or others who arent as comfortable with the technology.

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Cms Expands Medicare Coverage For All Cgms

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CMS will expand Medicare coverage for all types of continuous glucose monitors, including adjunctive and non-adjunctive CGMs.

The final rule, issued Dec. 21, classifies adjunctive CGMs under the Medicare Part B benefit for durable medical equipment and finalizes certain DME payment provisions that were included in two interim final rules. It will be effective starting 60 days after official publication.

The Durable Medical Equipment, Prosthetics, Orthotics and Supplies final rule aligns with the key goals of the administration to create a health care system that results in better accessibility, quality, affordability, empowerment and innovation, CMS stated on its web site.

In a fact sheet, noted it is not finalizing the proposed categories of supplies and accessories and fee schedule amounts for three types of CGM systems.

After consideration of public comments, CMS does not believe it is necessary at this time to further stratify the types of CGMs beyond the two categories of non-adjunctive and adjunctive CGMs, the agency stated. The fee schedule amounts for the newly covered adjunctive CGMs and related supplies and accessories will be established in accordance with existing regulations for establishing fee schedule amounts for new durable medical equipment items and services without a fee schedule pricing history at 42 CFR 414.238.

Reference:

What Medicare Members Would Pay

CMS had originally proposed three different categories of payment for those using the different types of CGM technology. The logic was that some didnt require fingersticks so users wouldnt need reimbursement for test strips, as would other systems that still require calibration . It also viewed the FreeStyle Libre flash glucose monitoring a bit differently than other tech, like Dexcom and Eversense. So it proposed different reimbursements for those varying styles of tech.

However, CMS has re-thought that move after public outcry. In its new December 2021 rule comments, the agency noted this:

After consideration of public comments, CMS does not believe it is necessary at this time to further stratify the types of CGMs beyond the two categories of non-adjunctive and adjunctive CGMs.

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Superior Medicare Patient Coverage

Advanced Diabetes Supply has specialized and created a unique expertise in working with Medicare patients and beneficiaries. Advanced Diabetes Supply was the first Medicare distributor to have obtained Medicares required DMEPOS Accreditation. We continue to lead the industry, honing our processes and understanding of Medicare, its coverage and coverage requirements.

Does Medicare Pay For Dexcom Cgm

Dexcom G6 Glucose Sensor (3pk) Medicaid/Medicare

DexcomMedicareMedicare coverageMedicare coverageCGM

. Herein, 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.

Secondly, how much does a Dexcom CGM cost? For those paying retail, cash price: Box of sensors: $349 Two transmitters: $475 per bundle

Simply so, does Medicare pay for dexcom g6?

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 .

How much does Medicare cover for dexcom?

A: According to Dexcoms Medicare FAQ page, those covered by Medicare can expect to pay 20% of the costs of their G5 CGM, which is roughly $50 per month. Medicare will cover the remaining 80%.

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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.

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