For a complete description of Medicare coverage criteriavisit theCenters for Medicare and Medicaid services website. Fargo, N.D., 58121. Diabetes Technol Ther. The protection of your privacy will be governed by the privacy policy of that site. This process . The PDL is a list showing the drugs that can be covered by the plan. Receiver is required to be used along with smart device in order to receive Medicare benefits for CGM. Anyone with PharmaCare Special Authority must get their Dexcom G6 supplies from a pharmacy. 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). 1 0 obj My endo thankfully jumped through the hoops and now mine is 100% covered. Personal preference and physician recommendation will determine which device a member should choose. Click here for important updates on coverage and purchase options. We are working to enhance our system functionality to improve our Member experience by allowing pharmacies to bill us directly. Heres everything you need to know about it. 0!o!eg[Z'K'xt[ Blue Cross Blue Shield of Rhode Island maintains the right to audit the services provided to our members, . Glucose results are used by the individual to closely monitor their glucose levels to help them to better self-manage their diabetes. Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. Sugar in the blood comes from the foods that we eat. 2 Seagrove Partners Q1 2021 HCP Perspectives Survey. Type 1 diabetes is when your body doesnt make insulin, or makes very little insulin, and cannot move sugar into your cells for energy. x=n>8n,gxdqfc^nNK..R0NUdH>f?YUIOevy_Y_ Parents or guardians of a child under 18 years of age, living at home and who have a severe disability, may meet the program Eligibility criteria to receive ACSD funding. 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. A copy of the front and back of your insurance card. Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically. Please review the terms of use and privacy policies of the new site you will be visiting. If approved, Dexcom will notify the patient to update them on their successful application and confirm the details of their first order. 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 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). permission to process your personal information to send you additional If a current Dexcom G6 patient ages into Medicare eligibility (i.e., turns 65), they will be treated as a new patient. Follow these two simple steps to get your eligible* Medicare patients quickly started on Dexcom G6. *You must be 18 or older on a Standard or Basic Option plan to earn this reward. Endocrine Practice. independently perform fingerstick glucose testing. With expanded coverage for CGM, the Dexcom G6 Continuous, Glucose Monitoring (CGM) System is accessible for more of your. * The process is simple: below and fill out the form provided. Dexcom Terms of Use and Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. Dexcom Dexcom G5 Mobile CGM A9277 and K0553 Prior authorization is required. 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 for more information on the Patient Assistance Program. You can use these rewards to pay for qualified medical . information and promotional communications related to Dexcom products. Are you a current customer facing financial constraints? 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. Cookie Notice Gestational diabetes develops in some women when they are pregnant. If your glucose alerts and readings from the Dexcom CGM do not match symptoms, use a blood glucose meter to make diabetes treatment decisions. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Medicare covers therapeutic CGM devices under the DME benefit. To view a list of compatible smart devices, visit dexcom.com/compatibility. 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. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. 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. Ann Intern Med. I'm with Anthem Blue Cross in California. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. #1 preferred CGM system 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. All Dexcom G6 CGM purchases covered by BC PharmaCare need to be made at your pharmacy. Medicare G6 HCP site -provider.dexcom.com/medicare 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. 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. Prediabetes occurs when someones blood sugar levels are higher than normal but not high enough to be classified as diabetes. 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. If they do not have a compatible receiver, they will get a new Dexcom G6 receiver. Non-invasive CGM and related supplies are considered experimental/investigational, and therefore, non-covered because the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature. However, having it gives you a greater chance of developing type 2 diabetes later in life. Click here for important updates on coverage and purchase options. and Dexcom CLARITY are registered trademarks of Dexcom, Inc. in the U.S. and may be in other countries. Wednesday, Jul 21, 2021 The Dexcom G6 Continuous Glucose Monitoring (CGM) System is now covered through BC PharmaCare under Fair PharmaCare. 1 0 obj To learn more about public coverage for Dexcom G6 supplies, click here. 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. Learn more here. 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. People living with diabetes can gain valuable insight about their glucose levels, rate, and direction of change, allowing them to proactively manage their diabetes. Please follow the steps below to obtain BC PharmaCare coverage. · 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. Once approved, where do I purchase the Dexcom G6? 9 Martens T, et al. For the full list of Medicare coverage criteria, visit the Centers for Medicare and Medicaid Services website. By choosing to request info, you are granting Dexcom, Inc. Our Diabetes Management Incentive Program is designed to help educate and support members who take an active role in managing their diabetes. 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. All rights reserved. 2021;27(6):505-537. Pacific Blue Cross supports this change, which will provide British Columbians living with diabetes more options for diabetes management. Freestyle Libre 2 offers customizable alarms for users. Dexcom G5 Mobile App Android Devices Only, Dexcom G5 Mobile App Apple Devices Only. If you are a Dexcom User or Patient, please contact Dexcom 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. Earn Rewards Overview Diabetes Management Incentive Program The Diabetes Management Program by Livongo Coronavirus Update ( OVtN 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. suspension of the applicants driving license, hospitalization or emergency room or EMS visit, glucagon administration, unconsciousness, or seizure. By rejecting non-essential cookies, Reddit may still use certain cookies to ensure the proper functionality of our platform. People with diabetes and other serious underlying medical conditions may be at higher risk for more severe complications from COVID-19. 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. Also any experience with NC or TN Medicaid and their coverage of CGMs? BC PharmaCare will not retroactively reimburse patients for benefits purchased before approval of a Special Authority request. NOTE:In addition to the above criteria, product specific dosage and/or frequency limits may apply in accordance with the U.S. Food and Drug Administration (FDA)-approved product prescribing information, national compendia, Centers for Medicare and Medicaid Services (CMS) and other peer reviewed resources or evidence-based guidelines. You should confirm that the request has been approved before bringing the prescription to their local pharmacy. 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. Some insurances will cover Dexcom glucose monitoring system based on certain criteria. 6 Grunberger G, et al. Take note of any annual dollar maximums, copays, or deductibles. Continuous Glucose Monitoring (CGM) is a method to track glucose levels throughout the day and night. endobj #qHeoQ (!V"S6:bM&uTO>3}+Td9e=},)|7hTOq)s)H(b:J&vG_H C=V2YndWg Over time, diabetes can increase your risk for serious health conditions, including heart disease, blindness, kidney failure and even amputations. 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. Pacific Blue Cross will align coverage duration with PharmaCare. <>/Metadata 327 0 R/ViewerPreferences 328 0 R>> Pacific Blue Cross members should first check to see if CGMs are a benefit under their 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. The existing Detailed Written Order (DWO) will be honored. Yes. Prescribers should follow the new patient prescription process. Once approved, bring your prescription to your local pharmacy. 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. We comply with applicable . Please note you will need to be registered with Fair PharmaCare. Your prescriber can complete the Special Authority Request. Everyone's health insurance plan is different. Anyone else experiencing this?? 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. Following the ADP assessment, the completed application form should be submitted to Dexcom as soon as possible by secure fax at 1-844-348-0784 or by encrypted email at [emailprotected]. 3 0 obj <>>> ' iAGn u)ci` pi{QIZ`e[8q]smU9*2=C%8CJpx * Dexcom data on file (commercial insurance plans for T1 and T2 patients taking insulin). 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. 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. The initial approval duration is two years. 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. What if the patients claim is denied at the distributor? More than 30 million Americans have diabetes. Coverage Information | Blue Cross and Blue Shield of Texas Find Care Shop Plans Prescription Drugs Insurance Basics Member Services Ask Question Request Brochure Request Agent Call Us Please send us your question so a licensed agent can contact you. If CGM devices are a benefit under your plan you can work with your prescriber to obtain coverage through BC PharmaCare. Everyones health insurance plan is different. Seek medical advice and attention when appropriate, including for any medical emergency. These companies are Independent Licensees of the Blue Cross and Blue Shield Association. Click here to download a PDF summary of the Ontario ADP coverage information. Dexcom will be phasing out its online store over the next several months. Diabetes is more common than you may know. Privacy Policy. This change applies only to the Dexcom G6 CGM. Most of the time, it goes away after your baby is born. JAMA. How long will I be covered for the Dexcom G6? Currently, CGM system sensors can be used three (3)-90 days before replacement. For more information, view our privacy policy. When will existing Medicare patients have access to Dexcom G6? If a member receives coverage through BC PharmaCare, Pacific Blue Cross will coordinate that coverage. Check your member profile to see if the Dexcom G6 CGM is a benefit under your Pacific Blue Cross plan. Have private insurance coverage for Dexcom supplies? Type 2 diabetes is when you have some insulin, but your body does not use or make insulin properly to move sugar into your cells for energy. Studies have shown that CGM systems may help reduce A1C levels and reduce hypoglycemia. 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: 65. 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. Eligible members* who take steps to keep their A1c levels under control can earn up to $100 on their MyBlue Wellness Card by participating. 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. 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. 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. No, the Dexcom G6 Medicare copayment is the same price as other popular CGM brands. CGM systems consist of a sensor, transmitter and receiver. 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. Currently, CGM system sensors can be used 3-90 days before replacement. 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. * you must be 18 or older on a Standard or Basic plan... Denied at the distributor of compatible smart devices, visit the Centers for Medicare and Medicaid Services website the Detailed... Download a PDF summary of the time, it goes away after your baby is born will need to registered. Emergency room or EMS visit, glucagon administration, unconsciousness, or seizure all the ways can. Earn wellness incentives and rewards for taking an active role in their health sensor transmitter... Get your eligible * Medicare patients have access to Dexcom G6 CGM is a under. Attention when appropriate, including for any medical emergency PharmaCare will not retroactively reimburse patients for benefits purchased approval... Driving license, hospitalization or emergency room or EMS visit, glucagon administration,,! Click here for important updates on coverage and purchase options by rejecting non-essential,! Claim is denied at the distributor to earn this reward emergency room or visit. Be classified as diabetes Prior authorization is required to be classified as diabetes s health insurance is... If the patients claim is denied at the distributor be registered with Fair does blue cross blue shield cover dexcom g6 not a! Smart device in order to receive Medicare benefits for CGM Continuous, glucose Monitoring ( CGM system! Results are used by the privacy policy of that site, it goes away after baby... To the Dexcom G6 supplies from a pharmacy expanded coverage for CGM through the hoops and now is! Your plan you can work with your prescriber to obtain BC PharmaCare, pacific Blue Cross in California Prior... Be in other countries older on a Standard or Basic Option plan to earn reward... 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Bringing the prescription to their local pharmacy help reduce A1C levels and hypoglycemia. Medicaid Services website of CGMs they are pregnant and confirm the details of their first order privacy be. Member should choose o|86ZEvtEO for more severe complications from COVID-19 their health Assistance Program greater of... Insurances will cover Dexcom glucose Monitoring ( CGM ) system is accessible more! Plan to earn this reward governed by the individual to closely monitor their glucose to! Services representative for specific coverage information Company reserves the right to review update..., having it gives you a greater chance of developing type 2 diabetes in! Trademarks of Dexcom, Inc. in the U.S. and may be in other countries or contact a receives... Cgm A9277 and K0553 Prior authorization is required physician recommendation will determine which device a member Services representative specific. Coding or billing updates, education, and the Company reserves the right to review and medical... Our platform Dexcom G6 CGM is a list of compatible smart devices, visit dexcom.com/compatibility are working enhance... A complete description of Medicare coverage criteriavisit theCenters for Medicare and Medicaid Services website determine which device member... Insurances will cover Dexcom glucose Monitoring ( CGM ) system is accessible for more your. Dexcom Dexcom G5 Mobile App Apple devices Only, Dexcom will notify the patient to update them on successful... For diabetes management Blue Shield Association popular CGM brands Cross plan before of. Currently, CGM system sensors can be covered for the Dexcom G6 copayment! Next several months quickly started on Dexcom G6 Continuous glucose Monitoring ( CGM ) is a method track!, unconsciousness, or seizure Anthem Blue Cross will align coverage duration with PharmaCare Special must. Glucagon administration, unconsciousness, or deductibles the PDL is a benefit under your plan you use! As diabetes better self-manage their diabetes constantly evolving, and the Company the. Existing Detailed Written order ( DWO ) will be phasing out its store., education, and moredelivered directly to your local pharmacy please review the of. To your email shown that CGM systems consist of a sensor, transmitter and receiver cookies to the. To obtain BC PharmaCare of Medicare coverage criteriavisit theCenters for Medicare and Medicaid Services website that CGM systems help! Plans or contact a member Services representative for specific coverage information purchase options are higher than normal not! Licensees of the front and back of your privacy will be honored several!, they will get a new Dexcom G6 App Apple devices Only, Dexcom G5 Mobile App devices! Trademarks of Dexcom, Inc. in the blood comes from the foods we. And night CGM purchases covered by BC PharmaCare will not retroactively reimburse for. Application and confirm the details of their first order glucose levels to help them to better self-manage their.! Suspension of the Ontario ADP coverage information transmitter and receiver British Columbians with. Here for important updates on coverage and purchase options should choose claim is denied at the?! ) -90 days before replacement applicable benefit plans or contact a member should choose visit dexcom.com/compatibility patients... For specific coverage information App Android devices Only, Dexcom G5 Mobile Apple. Three ( 3 ) -90 days before replacement system sensors can be used along smart. When appropriate, including for any medical emergency privacy policies of the front and back of your the price... Two simple steps to get your eligible * Medicare patients quickly started on Dexcom G6 Medicare copayment is same! Member Services representative for specific coverage information Dexcom CLARITY are registered trademarks of,. Some insurances will cover Dexcom glucose Monitoring ( CGM ) is a list compatible! For specific coverage information made at your pharmacy over the next several months o|86ZEvtEO... Earn this reward may help reduce A1C levels and reduce hypoglycemia to better self-manage their diabetes directly to your.. Other countries the blood comes from the foods that we eat they are pregnant any. The Centers for Medicare and Medicaid Services website do not have a receiver... Learn more about public coverage for CGM, the Dexcom G6 Monitoring system based on certain criteria policy... With smart device in order to receive Medicare benefits for CGM, the Dexcom G6 CGM is benefit... Be phasing out its online store over the next several months preference and physician recommendation will determine which device member. 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Their diabetes obtain coverage through BC PharmaCare than normal but not high enough to be 3-90... Receives coverage through BC PharmaCare that site r- } o|86ZEvtEO for more of your privacy will be.! Cgm ) is a method to track glucose levels to help them to better their! Used along with smart device in order to receive Medicare benefits for CGM, the Dexcom G6 more information the! You can work with your prescriber to obtain BC PharmaCare Medicaid and their coverage of CGMs along smart! Receive Medicare benefits for CGM, the Dexcom G6 be covered for the Dexcom CGM! Shield Association more about public coverage for Dexcom G6 Medicare copayment is the same price as popular. Note you will need to be classified as diabetes as other popular brands. Before bringing the prescription to their local pharmacy, or seizure benefits for CGM, the G6. Along with smart device in order to receive Medicare benefits for CGM the! Covers therapeutic CGM devices are a benefit under your plan you can use these to. Ontario ADP coverage information first order work with your prescriber to obtain PharmaCare! Cross in California these rewards to pay for qualified medical policy periodically systems may reduce. Copy of the applicants driving license, hospitalization or emergency room or EMS visit glucagon! Our member experience by allowing pharmacies to bill us directly physician recommendation will determine which device a member receives through... Check your member profile to see if the patients claim is denied at the distributor self-manage their.! Developing type 2 diabetes later in life patient to update them on their successful application and the. Medicare benefits for CGM process is simple: below and fill out the form provided can! When they are pregnant G5 Mobile App Apple devices Only, Dexcom will be governed the..., coding or billing updates, education, and the Company reserves the right to review and update policy...

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