Our Diabetes Management Incentive Program is designed to help educate and support members who take an active role in managing their diabetes. 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. How do I apply for coverage of the Dexcom G6? Discover how Dexcom G6 can empower your patients to make more informed For these members, CGMs will only be covered under their pharmacy benefit. Pacific Blue Cross will align coverage duration with PharmaCare. They simply complete a. Whats the difference between the Dexcom G6 CGM and the Freestyle Libre 2 System? <>/Metadata 327 0 R/ViewerPreferences 328 0 R>> Why is Dexcom referring patients to distributors? 3 dQ&A US Q1 2021 Diabetes Connections Patient Panel Report. Current patients may be eligible to receive ADP coverage for the sensors and transmitters used with their current rtCGM system if they meet all of the following: If your patient meets the criteria listed above, an ADP Application Form may be submitted on their behalf. 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@? 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. JAMA. By rejecting non-essential cookies, Reddit may still use certain cookies to ensure the proper functionality of our platform. Dexcom G6 Mobile CGM (Dexcom) was approved in 2018 and is indicated for the management of . Stay up to date on the latest Dexcom G7 news, availability dates, system features, and more! Talk to your doctor about which treatments, or combination of treatments, are right for you. 1310 G Street, N.W. Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. 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. What if the patients claim is denied at the distributor? Is Dexcom covered by public insurance plans? ADP will also notify the patient and prescribing healthcare provider at the DEP to provide the reason for denial. 4510 13th Ave. S. 2019;21(3):128-132. The Dexcom G6 costs approximately $3,600 annually and the Libre 2 Flash is approximately $2,600 annually. For a complete description of Medicare coverage criteriavisit theCenters for Medicare and Medicaid services website. Please provide the following information, so we can determine your coverage: A completed Patient Information form And one of the following: A completed patient insurance form or A copy of the front and back of your insurance card With this information, we will contact your insurance company and you to discuss your coverage options. I'm with Anthem Blue Cross in California. endobj Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Endocrine Practice. Contact your primary care provider or diabetes specialist to initiate the Special Authority approval process and to request a prescription for the Dexcom G6 CGM. BC PharmaCare will provide coverage to those who are 2 years old and up with diabetes mellitus and require multiple daily injections of insulin or insulin pump therapy as part of intensive insulin therapy. The PharmaCare Special Authority form will be the only one required to obtain coverage from Pacific Blue Cross. There is no change for any other CGM or Flash Glucose Monitor (Freestyle Libre or Libre 2) at this time. *28zVe +2a$ V Dexcom, Dexcom Clarity, Dexcom Follow, Dexcom One, Dexcom Share, and any related logos and design marks are either registered trademarks or trademarks of Dexcom, Inc. in the United States and/or other countries. Medicare covers therapeutic CGM devices under the DME benefit. What patient information is required within chart notes to ensure eligibility along with CMS Medicare coverage criteria? % 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. The patient/family/caregiver agrees to comprehensive and age-appropriate diabetes education by an interdisciplinary diabetes healthcare team and commits to regular follow-up. 2 0 obj Please submit your pharmacy receipt to Pacific Blue Cross for processing and payment. The easiest indication for Dexcom G6 or Dexcom G7 coverage by insurance is insulin use. 2 Seagrove Partners Q1 2021 HCP Perspectives Survey. #1 preferred CGM system *Medicare covers Dexcom G6 for insulin-requiring patients who meet the Medicare coverage criteria. 3 yr. ago. Patients can expect their ADP assessment to take approximately 2-3 weeks after the submission of their application form. What documents must be provided to my insurance company? Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. 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. 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. <> The information you provide will be sent securely and subject to the · Take note of any annual dollar maximums, copays, or deductibles. A patient must call their plan to confirm that the distributor is in their network. 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. Dexcom respects To be eligible for ODSP as a person with disability, patients must meet the program Eligibility criteria. The Dexcom G6 Continuous Glucose Monitoring (CGM) System is now covered through BC PharmaCare under Fair PharmaCare. Earn Rewards Overview Diabetes Management Incentive Program The Diabetes Management Program by Livongo Coronavirus Update If you are a Dexcom User or Patient, please contact Dexcom For patients currently using Dexcom G6 who turn 65 (becoming Medicare-eligible), how will they be transitioned to Dexcom G6 for Medicare? For more patient-focused information, please visit: Sign up to stay up to date with the latest CGM news, product updates and educational events. Your prescriber can complete the Special Authority Request. %PDF-1.5 Step 1: Ask your doctor to e-prescribe your Dexcom CGM supplies to your local pharmacy and to confirm coverage with your pharmacist. This applies for both new prescriptions and refills. Diabetes Overview - Blue Cross and Blue Shield's Federal Employee Program Diabetes Programs and resources to help you better understand, manage and prevent diabetes. These products are covered by U.S. patent. here. BRIEF SAFETY STATEMENT: Failure to use the Dexcom Continuous Glucose Monitoring System and its components according to the instructions for use provided with your device and available at https://www.dexcom.com/safety-information and to properly consider all indications, contraindications, warnings, precautions, and cautions in those instructions for use may result in you missing a severe hypoglycemia (low blood glucose) or hyperglycemia (high blood glucose) occurrence and/or making a treatment decision that may result in injury. By choosing to request info, you are granting Dexcom, Inc. BC PharmaCare diabetes supplies coverage and eligibility. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. To ensure a successful transaction, please confirm your submitted First Name and Last Name match that associated wtih your NPI number. 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. Most of the time, it goes away after your baby is born. * The process is simple: Click the link below and fill out the form provided. Proven clinical outcomes. Dexcom has decided to refer all Medicare patients to trusted distributors with experience serving Medicare patients. 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. You can use these rewards to pay for qualified medical . Over the next several months the Dexcom G6 online store will be phased out. Privacy Policy. Diabetes occurs when your body is unable to use sugar in the blood. Error: Please enter a valid email address. 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. 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. No changes will be made for coverage of other CGM devices. 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. 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. Frequent and unpredictable hypoglycemic episodes. At least one functional restriction that inhibits the use of blood glucose test strips (BGTS) (e.g., dexterity, mobility, dermatological problems). To continue receiving ADP coverage, patients must meet the Renewal Eligibility Criteria and complete the Renewal Form to confirm their continued eligibility every two years. All patients in Ontario with type 1 diabetes who meet the medical eligibility criteria, or would have met the medical eligibility criteria before they started on the Dexcom G6, should be referred for an assessment at an ADP registered clinic regardless of their current insurance status. 1 0 obj Will my insurance cover the Dexcom CGM System? 5 Centers for Medicare & Medicaid Services, Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs. Medicare patients currently using Dexcom G5 will be automatically updated to Dexcom G6 when their G5 transmitter is out of warranty. 2023 Dexcom Canada, Co. All rights reserved. To learn more about public coverage for Dexcom G6 supplies, click here. I'm wondering if those of you who use Blue Cross Blue Shield are able to get Tandem and Dexcom supplies. Dexcom CARE team - 1-877-339-2664 The ACSD website also contains information on How to apply. BC PharmaCare will not retroactively reimburse patients for benefits purchased before approval of a Special Authority request. 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. 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) This process typically takes 2-3 business days. For the full list of Medicare coverage criteria, visit the Centers for Medicare and Medicaid Services website. diabetes management decisions to help them stay in target glucose range. 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