If you are a healthcare provider and want to learn more about Dexcom, I'm with Anthem Blue Cross in California. 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. and our Health insurance is offered by Florida Blue. If they do not have a compatible receiver, they will get a new Dexcom G6 receiver. 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. 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. An adhesive patch holds the sensor in place so the sensor can measure glucose levels in the interstitial fluid. 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. Patients can expect their ADP assessment to take approximately 2-3 weeks after the submission of their application form. 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. 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. 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. endobj 8 Welsh JB, et al. Continuous Glucose Monitoring (CGM) is a method to track glucose levels throughout the day and night. 3 dQ&A US Q1 2021 Diabetes Connections Patient Panel Report. Endocrine Practice. 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. People living with diabetes can gain valuable insight about their glucose levels, rate, and direction of change, allowing them to proactively manage their diabetes. 1 deadbodyswtor 1 yr. ago Depends on the plan. 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. [CDATA[ Dexcom will submit the completed form to ADP on your patients behalf. Why is Dexcom referring patients to distributors? When completing the application, it may be necessary to answer No to the questions in section 2a/2b. 2017;167(6):365-374. CareCentrix is an independent company contracted with Florida Blue to manage durable medical equipment. Most people with type 1 diabetes on commercial health insurance are covered. This is the most common type of diabetes. No, the Dexcom G6 Medicare copayment is the same price as other popular CGM brands. Studies have shown that CGM systems may help reduce A1C levels and reduce hypoglycemia. %PDF-1.5 To help ensure uninterrupted coverage for these patients on their private health plan pending ADP determination, provide them with a prescription for Dexcom G6 with the notation "ADP Pending" written on it, in conjunction with their referral to ADP. Currently, CGM system sensors can be used three (3)-90 days before replacement. I'm wondering if those of you who use Blue Cross Blue Shield are able to get Tandem and Dexcom supplies. Since A1C is a three-month average, it doesnt give insight into potentially dangerous high and low glucose variations. Thats why its important to know your risk factors for type 2 diabetes and see your doctor regularly for blood glucose tests. What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. * The process is simple: below and fill out the form provided. To be eligible for coverage, individuals must meet the following Medical Eligibility Criteria: For your patients living with type 1 diabetes that meet the medical eligibility criteria stated above, they will need to be assessed and followed by healthcare professionals associated with a Diabetes Education Program (DEP) registered with the ADP. As far as I understand it, Dexcom is covered by your pharmacy benefit, not through Anthem. are under the supervision or care of an ADP-registered DEP; and. Are you a current customer facing financial constraints? aIJ'%d>8odMw|; dK^OpX`BHb 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. 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. 2019;6. #1 preferred CGM system Prescribers should follow the new patient prescription process. Anyone with PharmaCare Special Authority must get their Dexcom G6 supplies from a pharmacy. As such, we will be matching coverage criteria for the Dexcom G6 CGM for our Members. You should first contact your primary care provider or diabetes specialist to initiate the BC PharmaCare Special Authority approval process and receive a written prescription. Replacement is not covered due to loss, negligence or improper use. However, having it gives you a greater chance of developing type 2 diabetes later in life. If rejected, Dexcom will notify the patient of their unsuccessful application and discuss their options moving forward. 2 0 obj BC PharmaCare will not retroactively reimburse patients for benefits purchased before approval of a Special Authority request. CGM devices covered by Medicare are defined in CMS Ruling 1682R as 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. #qHeoQ (!V"S6:bM&uTO>3}+Td9e=},)|7hTOq)s)H(b:J&vG_H C=V2YndWg 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. This means they will automatically get a new Dexcom G6 transmitter and sensors with instructions on how to update the receiver and app. 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. Anyone else experiencing this?? x=n>8n,gxdqfc^nNK..R0NUdH>f?YUIOevy_Y_ Have private insurance coverage for Dexcom supplies? Medicare covers therapeutic CGM devices under the DME benefit. 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. We expect this functionality to be ready by the end of 2021. CGM systems consist of a sensor, transmitter and receiver. 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. Dexcom G6 supplies will be delivered at no cost to your patient. Diabetes Overview - Blue Cross and Blue Shield's Federal Employee Program Diabetes Programs and resources to help you better understand, manage and prevent diabetes. Our Diabetes Management Incentive Program is designed to help educate and support members who take an active role in managing their diabetes. * The process is simple: Click the link below and fill out the form provided. ' iAGn u)ci` pi{QIZ`e[8q]smU9*2=C%8CJpx Diabetes is more common than you may know. endobj 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. Please follow the steps below to obtain BC PharmaCare coverage. Once approved, where do I purchase the Dexcom G6? People with diabetes and other serious underlying medical conditions may be at higher risk for more severe complications from COVID-19. The PharmaCare Special Authority form will be the only one required to obtain coverage from Pacific Blue Cross. 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. 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. No changes will be made for coverage of other CGM devices. 4510 13th Ave. S. Error: Please enter a valid email address. 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. Also, many Medicare beneficiaries have secondary insurance that covers their copayment. At least one functional restriction that inhibits the use of blood glucose test strips (BGTS) (e.g., dexterity, mobility, dermatological problems). Is Dexcom covered by public insurance plans? N?[;IR. If you could not find answers to your questions, contact us directly for help. Earn Rewards Overview Diabetes Management Incentive Program The Diabetes Management Program by Livongo Coronavirus Update Dexcom G6 is available at the distributors listed below. If a member receives coverage through BC PharmaCare, Pacific Blue Cross will coordinate that coverage. The information you provide will be sent securely and subject to the First Name* Last Name* Phone* Email Address* How would you prefer to be contacted? 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