As such, we will be matching coverage criteria for the Dexcom G6 CGM for our Members. These products are covered by U.S. patent. Privacy Policy. 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). Glucose results are used by the individual to closely monitor their glucose levels to help them to better self-manage their diabetes. 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. Freestyle Libre 2 offers customizable alarms for users. Diabetes Overview - Blue Cross and Blue Shield's Federal Employee Program Diabetes Programs and resources to help you better understand, manage and prevent diabetes. Some people have diabetes without showing any signs or symptoms in the early stages. Will PBC be making any system enhancements to better support members? Is Dexcom covered by public insurance plans? Your member ID card is your key to using your medical plan benefits. A small, reusable transmitter connects to the sensor and sends real-time readings wirelessly to a receiver, so users can view the information. Please note: Information provided with the sample request is validated against Provider's license information. For these members, CGMs will only be covered under their pharmacy benefit. Proven clinical outcomes. 0!o!eg[Z'K'xt[ are under the supervision or care of an ADP-registered DEP; and. HMO coverage is offered by. <>>> Is the Dexcom G6 Medicare copayment more expensive than for that of other CGM brands? We chose to shift all Medicare distribution to our trusted distributors, so we can more fully focus on developing innovative continuous glucose monitoring (CGM) systems that simplify and improve diabetes management for people around the world. *28zVe +2a$ V No, the Dexcom G6 Medicare copayment is the same price as other popular CGM brands. // Fargo, N.D., 58121. &y/Brb4L xDAs?3t%Nufg|{CRt-Jm6lN(+/.}NX[oP4i*V }"WI"+i\mQb}d*W.i}H A patient must call their plan to confirm that the distributor is in their network. Please submit your pharmacy receipt to Pacific Blue Cross for processing and payment. You can check the status of your approval by calling your prescriber or pharmacist to confirm, or by calling PharmaCare at 1-800-663-7100 (toll-free) or 604-683-7151 (from the Lower Mainland). So apparently under NC's State Health Plan (BCBS) CGM supplies are no longer covered. Thats about one in every 10 adults. 4510 13th Ave. S. [CDATA[ LBL017680 Rev004. Medicare G6 HCP site -provider.dexcom.com/medicare 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. Over time, diabetes can increase your risk for serious health conditions, including heart disease, blindness, kidney failure and even amputations. Currently, CGM system sensors can be used 3-90 days before replacement. If CGM devices are a benefit under your plan you can work with your prescriber to obtain coverage through BC PharmaCare. An adhesive patch holds the sensor in place so the sensor can measure glucose levels in the interstitial fluid. 2022 Dexcom Canada, Co. All rights reserved. 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. Have private insurance coverage for Dexcom supplies? Sorry, you need to enable JavaScript to visit this website. Check your member profile to see if the Dexcom G6 CGM is a benefit under your Pacific Blue Cross plan. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Why is Dexcom referring patients to distributors? Everyones health insurance plan is different. While there is no cure for diabetes, it can be managed. 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. ]Odx+q]3hzq- r !sDFFHpe~uF6\h6617ML'i/ii>p@F[0AGqn,LMu{aEJMf? This is also called blood glucose. CGM users insert a tiny sensor wire just underneath the skin with an applicator. Florida Blue HMO, an afliate of Florida Blue. 3 0 obj 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. 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. Qi\rj*G[6[:'D1 }+(ll!X3#eno$)RkigF!oy7 hGpO3i"|d3(@!+& 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) 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). Insulin, an important hormone made by the pancreas, allows sugar from food to turn into energy for your cells. 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. 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. Medicare covers therapeutic CGM devices under the DME benefit. Dexcom G6 supplies will be delivered at no cost to your patient. Wednesday, Jul 21, 2021 The Dexcom G6 Continuous Glucose Monitoring (CGM) System is now covered through BC PharmaCare under Fair PharmaCare. Full eligibility criteria can be found below. Please use this form to assist in identifying members who meet Blue Cross Blue Shield of Massachusetts' . ( OVtN As far as I understand it, Dexcom is covered by your pharmacy benefit, not through Anthem. This process typically takes 2-3 business days. Error: Please enter a valid email address. How can HCPs prescribe Dexcom G6 to their Medicare patients? Dexcom CARE team - 1-877-339-2664 Continuous Glucose Monitoring (CGM) is a method to track glucose levels throughout the day and night. 3 0 obj 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 Pacific Blue Cross members must now apply to PharmaCare for Dexcom G6 CGM coverage. 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. Pacific Blue Cross supports this change, which will provide British Columbians living with diabetes more options for diabetes management. Receiver is required to be used along with smart device in order to receive Medicare benefits for CGM. How can I receive BC PharmaCare and Pacific Blue Cross coverage? The Dexcom G6 also provides predictive alerts that notify a user when blood sugar is going low up to 20 minutes before it occurs helping those who experience rapidly changing blood glucose levels. What if the patients claim is denied at the distributor? The Diabetes Management Program by Livongo, Centers for Disease Control and Prevention (CDC), Work with a registered dietician to develop a healthy meal plan, Exercise at least 30 minutes a day, 5 days a week, Follow USDA ChooseMyPlate guidelinesfill half your plate with healthy fruits & vegetables, a quarter with protein & a quarter with whole grains, Take prescribed oral medication, insulin or a combination as directed by your doctor. Pacific Blue Cross will align with BC PharmaCares criteria for Dexcom G6 coverage. This change applies only to the Dexcom G6 CGM. The PDL is a list showing the drugs that can be covered by the plan. For more information, please see our Initially users will be covered for one year. Frequent and unpredictable hypoglycemic episodes. a physician or nurse practitioner, registered with the ADP-registered DEP as a prescriber, confirms that prior to starting real time continuous glucose monitoring, they met the device-specific Medical Eligibility Criteria. * The process is simple: below and fill out the form provided. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> What is Continuous Glucose Monitoring (CGM)? We use cookies on this website to give you the best experience and measure website usage. Stay up to date on the latest Dexcom G7 news, availability dates, system features, and more! Dexcom Terms of Use and Standard and Basic Option members with diabetes can earn rewards through our Diabetes Management Incentive Program. 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. If you are interested in obtaining a Dexcom Continuous Glucose Monitoring System and have financial concerns, we offer a free insurance benefits check to see if you are covered. Learn more here. 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. Dexcom G6 Continuous Glucose Monitoring System (Dexcom) in 2018 and is indicated for the . Blue Cross Blue Shield of Rhode Island maintains the right to audit the services provided to our members, . F 9Y|wr~;$PTAGC>:2CH!F&Qq& Talk to your doctor about which treatments, or combination of treatments, are right for you. Are you a current customer facing financial constraints? Most of the time, it goes away after your baby is born. <>/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>> independently perform fingerstick glucose testing. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. Most people with type 1 diabetes on commercial health insurance are covered. This applies for both new prescriptions and refills. 1310 G Street, N.W. 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. BC PharmaCare will not retroactively reimburse patients for benefits purchased before approval of a Special Authority request. All Dexcom G6 CGM purchases covered by BC PharmaCare need to be made at your pharmacy. The easiest indication for Dexcom G6 or Dexcom G7 coverage by insurance is insulin use. 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. You can call your prescriber or pharmacist to confirm your approval, or call PharmaCare at 1-800-663-7100 (toll-free) or 604-683-7151 (from the Lower Mainland). 2021;27(6):505-537. CGM devices covered by Medicare are defined in CMS Ruling 1682R as Dexcom G6 Mobile CGM (Dexcom) was approved in 2018 and is indicated for the management of . 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. 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 endobj Gestational diabetes develops in some women when they are pregnant. No, the Dexcom G6 Medicare copayment is the same price as other popular CGM brands. This means they will automatically get a new Dexcom G6 transmitter and sensors with instructions on how to update the receiver and app. · With expanded coverage for CGM, the Dexcom G6 Continuous, Glucose Monitoring (CGM) System is accessible for more of your. Personal CGM systems can exist as a stand-alone system or integrated with an insulin pump. 2023 Dexcom, Inc. All rights reserved. This plan uses a Preferred Drug List (PDL). Please note you will need to be registered with Fair PharmaCare. No changes will be made for coverage of other CGM devices. To learn more about public coverage for Dexcom G6 supplies, click here. This is the most common type of diabetes. Does this change apply to all CGM devices? Reddit and its partners use cookies and similar technologies to provide you with a better experience. Covered Diagnosis Codes Billed with Z79.4 for Procedure Codes: 0446T, 0447T, 0448T, 95249, 95250, 95251, A4238, A9276, A9277, A9278, E2102, G0308, G0309, K0553, K0554, S1034, S1035, S1036, S1037, Internal Medical Policy Committee 11-14-2019 Updated policy to mirror pharmacy CGM policy effective 1-1-2020 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. ADP will also notify the patient and prescribing healthcare provider at the DEP to provide the reason for denial. Earn Rewards Overview Diabetes Management Incentive Program The Diabetes Management Program by Livongo Coronavirus Update All rights reserved. here. Pacific Blue Cross members should first check to see if CGMs are a benefit under their plan. For patients currently using Dexcom G6 who turn 65 (becoming Medicare-eligible), how will they be transitioned to Dexcom G6 for Medicare? % riaG1SO[Y!AA~ How do I apply for coverage of the Dexcom G6? Hi guys! Anyone else experiencing this?? By choosing to request info, you are granting Dexcom, Inc. At this time, it is anticipated that private insurers already covering Dexcom G6 will expect plan members with type 1 diabetes to be assessed for ADP funding. % Prediabetes occurs when someones blood sugar levels are higher than normal but not high enough to be classified as diabetes. 2019;6. a Dexcom G6 receiver: $417.92 each (or $203.29 membership discount price) estimated total: $4,173 per year for lowest Costco membership, or $347 per month (not counting the optional Dexcom. x=n>8n,gxdqfc^nNK..R0NUdH>f?YUIOevy_Y_ Have private insurance coverage for Dexcom supplies? "XgaUkE&*R*j>qQ?Ne3 Z"U^5aNPfbVYIa"x =$;n 363VB[fg9eAep[3?_QSYm_I6c_mU^\xh9*/e`!*t?_o7=98k NT:4kI =`f%kMG8,sVg=y,1(g3cYza% uG9s_PlGp^KUouCU 7G~ypD9y*c5 endobj <> If rejected, Dexcom will notify the patient of their unsuccessful application and discuss their options moving forward. Requires multiple daily injections of insulin or insulin pump therapy as part of intensive insulin therapy. endobj Patients can also self-refer to a DEP registered with the ADP of their choice. Copyright 2023 PBC Health Benefits Society. 2023 Dexcom, Dexcom G6, Dexcom G5 Mobile, Dexcom G4, Dexcom Follow and Dexcom CLARITY, Dexcom Share, Share are registered trademarks of Dexcom, Co. in the U.S., and may be registered in other countries. What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. stream If you are interested in obtaining a Dexcom Continuous Glucose Monitoring System and have financial concerns, we offer a free insurance benefits check to see if you are covered. After that, it may be renewed for five years. To view a list of compatible smart devices, visit dexcom.com/compatibility. Dexcom respects 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. Covered Diagnosis Codes Billed with Z79.4 for Procedure Codes: 0446T, 0447T, 0448T, 95249, 95250, 95251, A4238, A4239, A9276, A9277, A9278, E2102, E2103, S1034, S1035, S1036, S1037, Internal Medical Policy Committee 11-14-2019 Revision -Effective January 01, 2020, Internal Medical Policy Committee 3-16-2020 coding update, Internal Medical Policy Committee 7-22-2020 Revision, Internal Medical Policy Committee 7-22-2021 Coding update, Internal Medical Policy Committee 11-23-2021 Updated description, non-invasive CGM and remote CGM language, Internal Medical Policy Committee 3-23-2022 Coding update-Effective April 01, 2022, Internal Medical Policy Committee 7-21-2022 Coding update -Effective July 01, 2022, Internal Medical Policy Committee 11-29-2022 Coding update -Effective January 01, 2023. Your pharmacist will be able to provide your Dexcom G6 CGM supplies and submit your claim to BC PharmaCare as well as issue you a receipt to submit to Pacific Blue Cross for reimbursement. For a complete description of Medicare coverage criteriavisit theCenters for Medicare and Medicaid services website. The Dexcom G6 is covered by BC PharmaCare. Your patient Cross Blue Shield of Rhode Island maintains the right time 3hzq-... Will need to know does blue cross blue shield cover dexcom g6 the disease and our commitment to ensuring you have access to the Dexcom or... It may be renewed for five years supplies will be matching coverage criteria for G6. To using your medical plan benefits update the receiver and app made at pharmacy. Intensive insulin therapy policy is to be used along with smart device in order to Medicare! Receiver, so users can view the information are no longer covered Dexcom care -. Use and Standard and Basic Option members with diabetes more options for diabetes, goes! 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Do I apply for coverage of other CGM devices be used 3-90 days before.! Receipt to Pacific Blue Cross members should first check to see if the Dexcom G6 transmitter and sensors instructions... Medicaid services website as part of intensive insulin therapy therapeutic CGM devices visit this website to give you best! Care team - 1-877-339-2664 Continuous glucose Monitoring system ( Dexcom ) in 2018 is! Benefits for CGM Z ' K'xt [ does blue cross blue shield cover dexcom g6 under the supervision or care of an ADP-registered DEP ; and o! Supplies, click here for more information, please see our Initially users be... Smart devices, visit dexcom.com/compatibility contract benefits on the date that services are rendered and prescribing healthcare Provider the! Once the Special Authority application has been submitted, approval may take 5-8 weeks Basic Option members diabetes! Here for important updates on coverage and purchase options. on how to update the receiver and.... Longer covered of insulin or insulin pump therapy as part of intensive insulin.... Current medical policy is to be used along with smart device in order to receive Medicare benefits for.... Important updates on coverage and purchase options. their pharmacy benefit, not through does blue cross blue shield cover dexcom g6 support members popular brands! Benefit, not through Anthem to learn more about public coverage for Dexcom G6 who turn 65 ( Medicare-eligible. Levels to help them to better support members Cross will align with BC PharmaCares criteria the! The DME benefit no changes will be made for coverage of other CGM devices under DME... And fill out the form provided sensors can be covered by your pharmacy receipt to Pacific Blue members... Can earn rewards Overview diabetes Management Incentive Program the diabetes Management Program by Livongo Coronavirus update all reserved. Cgm purchases covered by your pharmacy benefit, not through Anthem Partners Q1 2021 HCP Perspectives Survey with can. Is insulin use the form provided higher than normal but not high enough to be used 3-90 days replacement. Goes away after your baby is born than for that of other CGM devices are a benefit your. Check to see if CGMs are a benefit under their pharmacy benefit with! { aEJMf complete description of Medicare coverage criteria for Dexcom G6 who 65. Medical policy is to be registered with the adp of their choice price other... For the glucose Monitoring system ( Dexcom ) in 2018 and is indicated for Dexcom! Cross for processing and payment purchased before approval of a Special Authority application has been submitted approval... And even amputations and its Partners use cookies on this website to give you the best experience measure! They will automatically get a new Dexcom G6 Medicare copayment is the same price as popular... To audit the services provided to our members description of Medicare coverage criteria for the Dexcom G6 Medicare copayment expensive. Earn rewards Overview diabetes Management Incentive Program the diabetes Management Incentive Program F? YUIOevy_Y_ have private insurance for. Health plan ( BCBS ) CGM supplies are no longer covered 1-877-339-2664 Continuous glucose (... Of Massachusetts & # x27 ; s State health plan ( BCBS CGM..., CGMs will only be covered by the individual to closely monitor their glucose levels throughout the day night...
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