How is this posssible. The process for Pacific Blue Cross members to obtain coverage of the Dexcom G6 CGM is changing. No, the Dexcom G6 Medicare copayment is the same price as other popular CGM brands. You should confirm that the request has been approved before bringing the prescription to their local pharmacy. 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 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). please fill out the form and a representative will contact you. 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) 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. *28zVe +2a$ V 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. Some insurances will cover Dexcom glucose monitoring system based on certain criteria. Check out the changes and updates to our plan in 2023. Patients can also self-refer to a DEP registered with the ADP of their choice. A small, reusable transmitter connects to the sensor and sends real-time readings wirelessly to a receiver, so users can view the information. If they do not have a compatible receiver, they will get a new Dexcom G6 receiver. 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. If a patient is already enrolled with ODSP or ACSD, they may fill out our Consent and Information Form and return it to us by encrypted email at [emailprotected], or by secure fax at 1-844-348-0784. CGM systems consist of a sensor, transmitter and receiver. 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. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. 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 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. Dexcom, headquartered in San Diego, is dedicated to helping people better manage their diabetes by developing and marketing continuous glucose monitoring (CGM) products and tools for adult and pediatric patients. Anyone with PharmaCare Special Authority must get their Dexcom G6 supplies from a pharmacy. Yes. Your patients may be eligible for CGM if they: For the full list of Medicare coverage criteria, visit the Centers for Medicare and Medicaid Services website. Pacific Blue Cross will align coverage duration with PharmaCare. People with diabetes and other serious underlying medical conditions may be at higher risk for more severe complications from COVID-19. Yes. Dexcom Tech support - 1-844-607-8398 The easiest indication for Dexcom G6 or Dexcom G7 coverage by insurance is insulin use. 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. Health insurance is offered by Florida Blue. Please provide the following information, so we can determine your coverage: With this information, we will contact your insurance company and you to discuss your coverage options. 2022 Dexcom Canada, Co. All rights reserved. Through a variety of programs and resources, were committed to helping you manage diabetes and take an active role in your health. Insulin, an important hormone made by the pancreas, allows sugar from food to turn into energy for your cells. endobj 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. Also, many Medicare beneficiaries have secondary insurance that covers their copayment. Eligible members* who take steps to keep their A1c levels under control can earn up to $100 on their MyBlue Wellness Card by participating. After that, it may be renewed for five years. 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. here. If you have prediabetes, there is a chance, with diet and exercise changes, that you can stop your bodys progression to fully diagnosed diabetes. Take note of any annual dollar maximums, copays, or deductibles. If a current Dexcom G6 patient ages into Medicare eligibility (i.e., turns 65), they will be treated as a new patient. 6 Grunberger G, et al. These companies are Independent Licensees of the Blue Cross and Blue Shield Association. 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. To ensure a successful transaction, please confirm your submitted First Name and Last Name match that associated wtih your NPI number. CGM systems consist of a sensor, transmitter and receiver. This applies for both new prescriptions and refills. Pacific Blue Cross supports this change, which will provide British Columbians living with diabetes more options for diabetes management. HCPs can prescribe Dexcom G6 to one of the distributors below via the following steps: A patient must call their plan to confirm that the distributor is in their network. With the Dexcom G6 System, your current glucose data can be shown on a compatible smart device using the Dexcom G6 App, or on an optional receiver. Also, many Medicare beneficiaries have secondary insurance that covers their copayment. Dexcom G6 is also covered by both the Ontario Disability Support Program (ODSP) and Assistance for Children with Severe Disabilities Program (ACSD) as a Mandatory Special Necessities Benefit. independently perform fingerstick glucose testing. ( OVtN T2/2000/Tresiba,Ozempic,Metformin/Dex G6. LBL017668 Rev004 Everyone's health insurance plan is different. ;caDoOF4R[6HGl^G`@oYlg#(Q0@pa6RH These products are covered by U.S. patent. This process typically takes 2-3 business days. stream I was just denied coverage for dexcom. * The process is simple: Click the link below and fill out the form provided. 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. In such circumstances, it is recommended to complete a rtCGM Funding Exception Request Form (click to view sample) and submit it along with the ADP Application Form. %PDF-1.7 <> Medicare covers therapeutic CGM devices under the DME benefit. 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. Time in range is a powerful supplement to A1C because it shows a more complete picture of changes in glucose levels. Medicare G6 HCP site -provider.dexcom.com/medicare N?[;IR. *You must be 18 or older on a Standard or Basic Option plan to earn this reward. 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). Most of the time, it goes away after your baby is born. This change applies only to the Dexcom G6 CGM. 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. 9 Martens T, et al. You will no longer need to complete the Pacific Blue Cross prior authorization form. By continuing to use this website, you consent to these cookies. 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. Is Dexcom covered by public insurance plans? Our Diabetes Management Incentive Program is designed to help educate and support members who take an active role in managing their diabetes. Have private insurance coverage for Dexcom supplies? Some people have diabetes without showing any signs or symptoms in the early stages. All new and existing Pacific Blue Cross members must now apply for BC PharmaCare coverage of the Dexcom G6 CGM. EN Canada Language English franais Change Country. 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. Glucose results are used by the individual to closely monitor their glucose levels to help them to better self-manage their diabetes. endobj ADP will also notify the patient and prescribing healthcare provider at the DEP to provide the reason for denial. <> A copy of the front and back of your insurance card. Thats why its important to know your risk factors for type 2 diabetes and see your doctor regularly for blood glucose tests. Blue Cross Blue Shield of Rhode Island maintains the right to audit the services provided to our members, . Step 1: Ask your doctor to e-prescribe your Dexcom CGM supplies to your local pharmacy and to confirm coverage with your pharmacist. A customer representative will follow up with you to process a full insurance benefits check after reviewing your information. To be eligible for ODSP as a person with disability, patients must meet the program Eligibility criteria. 2 0 obj Why is Dexcom referring patients to distributors? Anyone else experiencing this?? Diabetes Technol Ther. Heres everything you need to know about it. Contact Dexcom to get the specific information you will need with your insurance plan as plan requirements vary. Dexcom G6 supplies will be delivered at no cost to your patient. Will my insurance cover the Dexcom CGM System? The Dexcom G6 Continuous Glucose Monitoring (CGM) System is now covered through BC PharmaCare under Fair PharmaCare. &y/Brb4L xDAs?3t%Nufg|{CRt-Jm6lN(+/.}NX[oP4i*V }"WI"+i\mQb}d*W.i}H Since A1C is a three-month average, it doesnt give insight into potentially dangerous high and low glucose variations. If you could not find answers to your questions, contact us directly for help. What documents must be provided to my insurance company? Florida Blue HMO, an afliate of Florida Blue. 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. Dexcom will submit the completed form to ADP on your patients behalf. Your member ID card is your key to using your medical plan benefits. 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. <> 2021;27(6):505-537. Once the Special Authority application has been submitted, approval may take 5-8 weeks. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Click here to download a printable PDF copy of the ADP Application for Funding Real-Time Continuous Glucose Monitoring System (rtCGM). As far as I understand it, Dexcom is covered by your pharmacy benefit, not through Anthem. 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. LBL017680 Rev004. 2023 Dexcom Canada, Co. All rights reserved. suspension of the applicants driving license, hospitalization or emergency room or EMS visit, glucagon administration, unconsciousness, or seizure. Does this change apply to all CGM devices? 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. I may be moving to South Carolina later this year, and apparently that's my only option unless I go off-exchange for my health insurance. Replacement is not covered due to loss, negligence or improper use. 4 0 obj Applicant had severe hypoglycemia in the past 2 years without an obvious precipitant, despite optimized use of insulin therapy and glucose monitoring (at least 4 times/day) which result in one of the following. I'm with Anthem Blue Cross in California. Receiver is required to be used along with smart device in order to receive Medicare benefits for CGM. My endo thankfully jumped through the hoops and now mine is 100% covered. and Dexcom CLARITY are registered trademarks of Dexcom, Inc. in the U.S. and may be in other countries. So apparently under NC's State Health Plan (BCBS) CGM supplies are no longer covered. 4 0 obj Studies have shown that CGM systems may help reduce A1C levels and reduce hypoglycemia. I have used dexcom for over 10 years, dozens of different policies and never denied! Personal CGM systems can exist as a stand-alone system or integrated with an insulin pump. Dexcom CARE team - 1-877-339-2664 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. Blue Cross & Blue Shield of Rhode Island (BCBSRI) follows the medical necessity criteria from the Centers . You may opt-out of these communications at any time. Where can patients fill their Dexcom G6 scripts? E~"*`xne@? 4510 13th Ave. S. 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. 2 0 obj HMO coverage is offered by. You will be going to a new website, operated on behalf of the Blue Cross and Blue Shield Service Benefit Plan by a third party. Please follow the steps below to obtain BC PharmaCare coverage.