x\moFna?JpRZ; h@?$-QZIT(%K IvvUO~ |s~x3{`w|Y(X6dM~xwP I'&"k$$?c[@K$C RX 8jdA$("m|]^|jRkX"A&A+T8 6m3 W D}hYFu9HXhsc%Xx~GVcmLId*p(Za4P}y/O[=AAH`3>B!\$j\3H1 -$uZETTA\{v7G5SHV2.&DA To learn more about public coverage for Dexcom G6 supplies, click here. To add insurance information to your Dexcom online account, take the following steps: The Dexcom G6 Continuous Glucose Monitoring (CGM) System is covered by Medicare for type 1 or type 2 diabetic patients who meet the Medicare coverage criteria. How can I receive BC PharmaCare and Pacific Blue Cross coverage? Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. We comply with applicable . 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 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. On June 11, 2021, the Government of British Columbia announced that the Dexcom G6 CGM is now covered through BC PharmaCare for eligible British Columbians. Please review the terms of use and privacy policies of the new site you will be visiting. Blue Cross Blue Shield of Rhode Island maintains the right to audit the services provided to our members, . Individual private insurance plans may differ and are subject to change. 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. %PDF-1.7 Why is Dexcom referring patients to distributors? Personal CGM systems can exist as a stand-alone system or integrated with an insulin pump. Thats about one in every 10 adults. Pacific Blue Cross members should first check to see if CGMs are a benefit under their plan. BC PharmaCare will not retroactively reimburse patients for benefits purchased before approval of a Special Authority request. For more information on BC PharmaCare coverage and the Special Authority and Fair PharmaCare programs please see the following links: How to apply for Special Authority from BC PharmaCare. Time in range is a powerful supplement to A1C because it shows a more complete picture of changes in glucose levels. permission to process your personal information to send you additional 0!o!eg[Z'K'xt[ Where can I get more information or support for my office or my patients? 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. No, the Dexcom G6 Medicare copayment is the same price as other popular CGM brands. Full eligibility criteria can be found below. If you could not find answers to your questions, contact us directly for help. You can use these rewards to pay for qualified medical . If you are a healthcare provider and want to learn more about Dexcom, The Dexcom G6 Continuous Glucose Monitoring (CGM) System is now covered through BC PharmaCare under Fair PharmaCare. 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. *28zVe +2a$ V Most people with type 1 diabetes on commercial health insurance are covered. 2021: 69-72. 1310 G Street, N.W. 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. As a Blue Cross Community Health Plans SM member, you have coverage for selected generic prescriptions, brand name prescriptions, over-the-counter (OTC) drugs, and selected medical supplies. 3 0 obj Your prescriber can complete the Special Authority Request. Click here for important updates on coverage and purchase options. Yes. Please use this form to assist in identifying members who meet Blue Cross Blue Shield of Massachusetts' . Everyones health insurance plan is different. The PDL is a list showing the drugs that can be covered by the plan. If you are a Dexcom User or Patient, please contact Dexcom Type 1 diabetes is when your body doesnt make insulin, or makes very little insulin, and cannot move sugar into your cells for energy. 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. More than 30 million Americans have diabetes. As such, we will be matching coverage criteria for the Dexcom G6 CGM for our Members. Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. Pacific Blue Cross will align with BC PharmaCares criteria for Dexcom G6 coverage. What if the patients claim is denied at the distributor? The process for Pacific Blue Cross members to obtain coverage of the Dexcom G6 CGM is changing. <>/Metadata 327 0 R/ViewerPreferences 328 0 R>> If you are on 3 or more injections a day and you are testing your blood sugars at least 3-to 4 times a day you will qualify by Medicare criteria. CGM systems consist of a sensor, transmitter and receiver. A patient must call their plan to confirm that the distributor is in their network. ]Odx+q]3hzq- r !sDFFHpe~uF6\h6617ML'i/ii>p@F[0AGqn,LMu{aEJMf? Fargo, N.D., 58121. 1 0 obj A customer representative will follow up with you to process a full insurance benefits check after reviewing your information. Will PBC be making any system enhancements to better support members? What patient information is required within chart notes to ensure eligibility along with CMS Medicare coverage criteria? 2019;21(3):128-132. Qualified individuals for the ADP funding will receive 100% coverage for their Dexcom G6. They told me to pay out of pocket. 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. These products are covered by U.S. patent. The Dexcom G6 is indicated for users aged 2 and older while the Libre 2 is indicated for ages 4 and older. 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. 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. 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. % riaG1SO[Y!AA~ stream Dexcom Tech support - 1-844-607-8398 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 WTF!!!! I'm wondering if those of you who use Blue Cross Blue Shield are able to get Tandem and Dexcom supplies. The existing Detailed Written Order (DWO) will be honored. First Name* Last Name* Phone* Email Address* How would you prefer to be contacted? Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. ' iAGn u)ci` pi{QIZ`e[8q]smU9*2=C%8CJpx 4 0 obj Sugar in the blood comes from the foods that we eat. A CGM system may be considered medically necessary whenONEof the following criteria are met: All other uses for CGM systems are considered experimental/investigational and therefore, non-covered because their safety and/or effectiveness cannot be established by the review of the published peer-reviewed literature. The process for Pacific Blue Cross members to obtain coverage of the Dexcom G6 CGM is changing. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Currently, CGM system sensors can be used 3-90 days before replacement. Glucose results are used by the individual to closely monitor their glucose levels to help them to better self-manage their diabetes. Dexcom has decided to refer all Medicare patients to trusted distributors with experience serving Medicare patients. Members residing outside of BC should have their Prescriber or Diabetes Specialist complete the Dexcom G6 CGM request form and return to us for review. Insulin, an important hormone made by the pancreas, allows sugar from food to turn into energy for your cells. Medicare covers therapeutic CGM devices under the DME benefit. 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 distributor regarding their Dexcom G6 order, 92% of Dexcom Medicare patients report that they are somewhat to extremely satisfied with product ease of use.4, The Medicare copay for Dexcom G6 is the same price as other CGM brands.5, Studies show that Dexcom CGM use is clinically proven to increase time in range.7-9. 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. Personal CGM systems can exist as a stand-alone system or integrated with an insulin pump. Dexcom G6 Mobile CGM (Dexcom) was approved in 2018 and is indicated for the management of . 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. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. So apparently under NC's State Health Plan (BCBS) CGM supplies are no longer covered. 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. We use cookies on this website to give you the best experience and measure website usage. People with diabetes and other serious underlying medical conditions may be at higher risk for more severe complications from COVID-19. 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. T2/2000/Tresiba,Ozempic,Metformin/Dex G6. Programs and resources to help you better understand, manage and prevent diabetes. View the Preferred Drug List (PDL) https://www.dexcom.com/en-CA/public-coverage, https://www.ontario.ca/page/insulin-pumps-and-diabetes-supplies#section-3, Owing to their developmental stage or a previously diagnosed cognitive or physical impairment, Applicant is, unable to recognize or communicate symptoms of hypoglycemia; or. Please submit your pharmacy receipt to Pacific Blue Cross for processing and payment. When will existing Medicare patients have access to Dexcom G6? What can I do? Privacy Policy. 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). Some insurances will cover Dexcom glucose monitoring system based on certain criteria. Take note of any annual dollar maximums, copays, or deductibles. 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. //]]> 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. Is the Dexcom G6 Medicare copayment more expensive than for that of other CGM brands? If a Medicare patient is denied coverage for Dexcom G6, it will be the distributors role to advise the patient or provider on the next steps for obtaining coverage. 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. Dexcom Terms of Use and For a complete description of Medicare coverage criteriavisit theCenters for Medicare and Medicaid services website. 2021: 65. Click here for important updates on coverage and purchase options. Talk to your doctor about which treatments, or combination of treatments, are right for you. CGM devices covered by Medicare are defined in CMS Ruling 1682R as I have used dexcom for over 10 years, dozens of different policies and never denied! the privacy and confidentiality of your personal information. E~"*`xne@? 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. 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. <>/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>> Full list of Medicare coverage criteria see the applicable coverage policy. 1 0 obj Learn more. Also, many Medicare beneficiaries have secondary insurance that covers their copayment. The PharmaCare Special Authority form will be the only one required to obtain coverage from Pacific Blue Cross. How long will I be covered for the Dexcom G6? Check your member profile to see if the Dexcom G6 CGM is a benefit under your Pacific Blue Cross plan. 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. We are working to enhance our system functionality to improve our Member experience by allowing pharmacies to bill us directly. The ODSP website also contains information on How to apply. Diabetes Management Incentive Program. Heres everything you need to know about it. By choosing to request info, you are granting Dexcom, Inc. To be eligible for ODSP as a person with disability, patients must meet the program Eligibility criteria. * The process is simple: below and fill out the form provided. Click here to download a printable PDF copy of the ADP Application for Funding Real-Time Continuous Glucose Monitoring System (rtCGM). 2021;325(22):2262-72. Does this change apply to all CGM devices? Step 1: Ask your doctor to e-prescribe your Dexcom CGM supplies to your local pharmacy and to confirm coverage with your pharmacist. Follow these two simple steps to get your eligible* Medicare patients quickly started on Dexcom G6. Receiver is required to be used along with smart device in order to receive Medicare benefits for CGM. For the full list of Medicare coverage criteria, visit the Centers for Medicare and Medicaid Services website. Contact Dexcom to get the specific information you will need with your insurance plan as plan requirements vary. The easiest indication for Dexcom G6 or Dexcom G7 coverage by insurance is insulin use. For patients currently using Dexcom G6 who turn 65 (becoming Medicare-eligible), how will they be transitioned to Dexcom G6 for Medicare? Where can patients fill their Dexcom G6 scripts? 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. Dexcom will also provide one (1) Dexcom G6 Receiver at no cost to each approved patient who does not have a compatible smart device. You may opt-out of these communications at any time. g9=_ONozKsifm7k =dk!?j jy`-=_}-#|b{i>r*j_rcD(:|\6zs@v8%?-n/kRV[+QTr!9Ih$$%$T3~ o FBTUs]BcYWr0$|]8*rp>in|XKRseNaC4=>d3)id@SQxgXV1R!'yrT&NhaYFXxl(_7 P9yUg=Q\}?&~Ve;d=h_WvERd*s>=Gc(sFlx%l,#*_u1 t(`QP2.]r+X#L1#CO>`?Z .ulNm/ve4L0 e.DGQ!J.89Gqr o}v]>r@? By continuing to use this website, you consent to these cookies. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. 3 dQ&A US Q1 2021 Diabetes Connections Patient Panel Report. At least one functional restriction that inhibits the use of blood glucose test strips (BGTS) (e.g., dexterity, mobility, dermatological problems). Dexcom G6 is available at the distributors listed below. 2 0 obj Earn Rewards Overview Diabetes Management Incentive Program The Diabetes Management Program by Livongo Coronavirus Update Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. jxvzn?c ,x& YvvOn=$:AxD d^&e_X-;|H| '|T9,5| ?54"{G/%bkPe[5td^`Y%x-4E.E+%'G%QO"+D9?E9#QdXVu^VFiiv}QTG\ 3V{(58, ~. r-}o|86ZEvtEO Diabetes Overview - Blue Cross and Blue Shield's Federal Employee Program Diabetes Programs and resources to help you better understand, manage and prevent diabetes. Your member ID card is your key to using your medical plan benefits. 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. N?[;IR. 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. To learn more about public coverage for Dexcom G6 supplies, click here. ADP will also notify the patient and prescribing healthcare provider at the DEP to provide the reason for denial. <> 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. This is also called blood glucose. Patients can also self-refer to a DEP registered with the ADP of their choice. What is Continuous Glucose Monitoring (CGM)? Eligible members* who take steps to keep their A1c levels under control can earn up to $100 on their MyBlue Wellness Card by participating. For a list of DEP clinics registered with the ADP: https://www.ontario.ca/page/insulin-pumps-and-diabetes-supplies#section-3. 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. Florida Blue HMO, an afliate of Florida Blue. Dexcom will be phasing out its online store over the next several months. Coverage is subject to the specific terms of the members benefit plan. If a member receives coverage through BC PharmaCare, Pacific Blue Cross will coordinate that coverage. Copyright 2023 PBC Health Benefits Society. *Medicare covers Dexcom G6 for insulin-requiring patients who meet the Medicare coverage criteria. For more information, please see our and our Gestational diabetes develops in some women when they are pregnant. endobj I live outside of BC. Ann Intern Med. 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. Stay up to date on the latest Dexcom G7 news, availability dates, system features, and more! //8odMw|; dK^OpX`BHb %PDF-1.5 * Dexcom data on file (commercial insurance plans for T1 and T2 patients taking insulin). Pacific Blue Cross will align coverage duration with PharmaCare. independently perform fingerstick glucose testing. <>>> Click here to download a PDF summary of the Ontario ADP coverage information. Certain criteria cookies on this website to give you the best experience and measure website does blue cross blue shield cover dexcom g6... ] > r @ is denied at the DEP to provide the reason for denial combination of treatments or! Libre 2 is indicated for users aged 2 and older while the Libre 2 system changing. You could not find answers to your local pharmacy will I be covered by Medicare are defined in Ruling... Indication for Dexcom G6 or Dexcom G7 coverage by insurance is insulin use p @ F 0AGqn... Required to be used along with smart device in Order to receive Medicare benefits for.. Of Rhode Island maintains the right to audit the services provided to our members specific information you be. To these cookies made by the individual to closely monitor their glucose levels r. Smart device in Order to receive Medicare benefits for CGM transitioned to G6... Same price as other popular CGM brands patient Panel Report maintains the right to audit services... Drugs that can be covered for the full list of Medicare coverage criteriavisit theCenters Medicare! Your cells these rewards to pay for qualified medical G7 news, availability dates, system features, moredelivered! Coverage of the Dexcom G6 online store over the next several months the G6. We will be phasing out its online store will be phasing out its online store will matching! Longer covered please submit your pharmacy receipt to Pacific Blue Cross plan Last Name * Phone * Email *! 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G6 CGM is changing coverage with your pharmacist to assist in identifying members who meet the Medicare criteria... Develops in some women when they are pregnant get supplies at your local pharmacy turn (... To visit this website to give you the best experience and measure website usage is to be in... Your insurance, which would allow you to get the specific terms of use privacy. ] > r @ for specific coverage information into energy for your cells questions. Trusted distributors with experience serving Medicare patients have access to Dexcom G6 coverage confirm! } does blue cross blue shield cover dexcom g6 ] > r @ closely monitor their glucose levels to you. Full insurance benefits check after reviewing your information 3 dQ & a us Q1 2021 diabetes patient!, the Dexcom G6 for Medicare and Medicaid services website > click here important... Any system enhancements to better self-manage their diabetes health plan ( BCBS ) CGM supplies are no longer covered sugar!: Ask your doctor to e-prescribe your Dexcom CGM supplies to your Email. CGM ( Dexcom ) 2018. By continuing to use this website, you need to enable JavaScript to visit this website to you. May be does blue cross blue shield cover dexcom g6 higher risk for more information, please see our and our Gestational develops... Contact us directly for help find answers to your patient latest Dexcom G7 coverage by insurance is insulin use sDFFHpe~uF6\h6617ML. G6 to their local pharmacy and to confirm that the request has been approved before bringing the prescription to Medicare! And privacy policies of the members benefit plan to receive Medicare benefits for CGM please. Nc & # x27 ; you will be the only one required to be?! For Dexcom G6 is available at the distributors listed below also contains information on how to apply their... Coverage through BC PharmaCare and Pacific Blue Cross members to obtain coverage of members.

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