Hi guys! If approved, Dexcom will notify the patient to update them on their successful application and confirm the details of their first order. Proven clinical outcomes. endobj You should confirm that the request has been approved before bringing the prescription to their local pharmacy. 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. We are working to enhance our system functionality to improve our Member experience by allowing pharmacies to bill us directly. CGM systems consist of a sensor, transmitter and receiver. 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. Type 1 diabetes is when your body doesnt make insulin, or makes very little insulin, and cannot move sugar into your cells for energy. Medicare G6 Patient site -www.dexcom.com/medicare. Time in range is a powerful supplement to A1C because it shows a more complete picture of changes in glucose levels. ?;E%}p}o]>H7 {"/:|Y }=l~Tx~dEW%[A+ |)Z9D%SE WW@Y\j7+nH! 2021: 69-72. Copyright 2023 PBC Health Benefits Society. If you could not find answers to your questions, contact us directly for help. 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. Please use this form to assist in identifying members who meet Blue Cross Blue Shield of Massachusetts' . You may have pharmacy coverage for Dexcom through your insurance, which would allow you to get supplies at your local pharmacy. Dexcom G6 supplies will be delivered at no cost to your patient. Eligible members* who take steps to keep their A1c levels under control can earn up to $100 on their MyBlue Wellness Card by participating. x=n>8n,gxdqfc^nNK..R0NUdH>f?YUIOevy_Y_ Is the Dexcom G6 Medicare copayment more expensive than for that of other CGM brands? How is this posssible. Learn more. 2 Seagrove Partners Q1 2021 HCP Perspectives Survey. *You must be 18 or older on a Standard or Basic Option plan to earn this reward. Dexcom will also provide one (1) Dexcom G6 Receiver at no cost to each approved patient who does not have a compatible smart device. Thats about one in every 10 adults. As such, we will be matching coverage criteria for the Dexcom G6 CGM for our Members. N?[;IR. Pacific Blue Cross members must now apply to PharmaCare for Dexcom G6 CGM coverage. If you are a healthcare provider and want to learn more about Dexcom, Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. Earn Rewards Overview Diabetes Management Incentive Program The Diabetes Management Program by Livongo Coronavirus Update <>>> 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) Where can I get more information or support for my office or my patients? Click here to download a printable PDF copy of the ADP Application for Funding Real-Time Continuous Glucose Monitoring System (rtCGM). We expect this functionality to be ready by the end of 2021. 2021: 65. What can I do? 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. Diabetes Overview - Blue Cross and Blue Shield's Federal Employee Program Diabetes Programs and resources to help you better understand, manage and prevent diabetes. <> Thats why its important to know your risk factors for type 2 diabetes and see your doctor regularly for blood glucose tests. What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. Have private insurance coverage for Dexcom supplies? I live outside of BC. Dexcom G6 is available at the distributors listed below. 2 0 obj Glucose results are used by the individual to closely monitor their glucose levels to help them to better self-manage their diabetes. The protection of your privacy will be governed by the privacy policy of that site. Dexcom will be phasing out its online store over the next several months. How long will I be covered for the Dexcom G6? 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 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. 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. However, having it gives you a greater chance of developing type 2 diabetes later in life. Standard and Basic Option members with diabetes can earn rewards through our Diabetes Management Incentive Program. The process for Pacific Blue Cross members to obtain coverage of the Dexcom G6 CGM is changing. Click here for important updates on coverage and purchase options. 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). 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. View the Preferred Drug List (PDL) and our I have used dexcom for over 10 years, dozens of different policies and never denied! By choosing to request info, you are granting Dexcom, Inc. <> 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. I'm wondering if those of you who use Blue Cross Blue Shield are able to get Tandem and Dexcom supplies. These products are covered by U.S. patent. Will PBC be making any system enhancements to better support members? endobj ' iAGn u)ci` pi{QIZ`e[8q]smU9*2=C%8CJpx Diabetes Technol Ther. 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. ( OVtN 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. Dexcom respects Currently, CGM system sensors can be used 3-90 days before replacement. Seek medical advice and attention when appropriate, including for any medical emergency. Follow these two simple steps to get your eligible* Medicare patients quickly started on Dexcom G6. If CGM devices are a benefit under your plan you can work with your prescriber to obtain coverage through BC PharmaCare. Are you a current customer facing financial constraints? They simply complete a. If they do not have a compatible receiver, they will get a new Dexcom G6 receiver. This applies for both new prescriptions and refills. E~"*`xne@? 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. 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. CGM users insert a tiny sensor wire just underneath the skin with an applicator. Learn more here. 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. For these members, CGMs will only be covered under their pharmacy benefit. How can I receive BC PharmaCare and Pacific Blue Cross coverage? <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 2017;167(6):365-374. Diabetes Management Incentive Program. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. CareCentrix is an independent company contracted with Florida Blue to manage durable medical equipment. independently perform fingerstick glucose testing. Error: Please enter a valid email address. Dexcom Terms of Use and These companies are Independent Licensees of the Blue Cross and Blue Shield Association. Once approved, bring your prescription to your local pharmacy. Sorry, you need to enable JavaScript to visit this website. 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. Sign up to receive our monthly email newsletter, tips for healthy living, and important updates. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. Over the next several months the Dexcom G6 online store will be phased out. 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. LBL017680 Rev004. 5 Centers for Medicare & Medicaid Services, Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs. What patient information is required within chart notes to ensure eligibility along with CMS Medicare coverage criteria? <> Also any experience with NC or TN Medicaid and their coverage of CGMs? Full eligibility criteria can be found below. 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. %PDF-1.5 This is also called blood glucose. Insulin, an important hormone made by the pancreas, allows sugar from food to turn into energy for your cells. To learn more about public coverage for Dexcom G6 supplies, click here. Dexcom will submit the completed form to ADP on your patients behalf. Will my insurance cover the Dexcom CGM System? 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. 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. JAMA. If you are a Dexcom User or Patient, please contact Dexcom Please note: Information provided with the sample request is validated against Provider's license information. 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. How can HCPs prescribe Dexcom G6 to their Medicare patients? Some people have diabetes without showing any signs or symptoms in the early stages. This is the most common type of diabetes. CGM systems consist of a sensor, transmitter and receiver. The Dexcom G6 Continuous Glucose Monitoring (CGM) System is now covered through BC PharmaCare under Fair PharmaCare. Click here to download a PDF summary of the Ontario ADP coverage information. 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. Dexcom has decided to refer all Medicare patients to trusted distributors with experience serving Medicare patients. 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]. 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. <> The PharmaCare Special Authority form will be the only one required to obtain coverage from Pacific Blue Cross. Our Diabetes Management Incentive Program is designed to help educate and support members who take an active role in managing their diabetes. % Personal CGM systems can exist as a stand-alone system or integrated with an insulin pump. 2023 Dexcom Canada, Co. All rights reserved. NOTE:Upgrade to or replacement of an existing CGM is considered not medically necessary when requested for convenience or simply to upgrade to a newer technology, when the current components remain functional, or when the current components remain under warranty. endobj 7E^DPN)0>fe E+gM2^6xX3,o):,`5-ihS,3Ei6^.h,.#=DaSv/ee)w(($2HG\Oz~:P+S~XysQ b~\ vT(PAQ{ 4\' @e^NN(eU. For more information on BC PharmaCare coverage and the Special Authority and Fair PharmaCare programs please see the following links: How to apply for Special Authority from BC PharmaCare. Please note you will need to be registered with Fair PharmaCare. This is to ensure that the medical devices and medications covered by our plans are the right products at the right price to protect both the health of our Members as well as the sustainability of our plans. Continuous Glucose Monitoring (CGM) is a method to track glucose levels throughout the day and night. If approved, your initial BC PharmaCare Special Authority approval period is valid for one year. 7 Beck RW, et al. Your member ID card is your key to using your medical plan benefits. Prediabetes occurs when someones blood sugar levels are higher than normal but not high enough to be classified as diabetes. stream jxvzn?c ,x& YvvOn=$: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 and Dexcom CLARITY are registered trademarks of Dexcom, Inc. in the U.S. and may be in other countries. This process . First Name* Last Name* Phone* Email Address* How would you prefer to be contacted? The PDL is a list showing the drugs that can be covered by the plan. Qi\rj*G[6[:'D1 }+(ll!X3#eno$)RkigF!oy7 hGpO3i"|d3(@!+& All rights reserved. Reddit and its partners use cookies and similar technologies to provide you with a better experience. 3 0 obj The existing Detailed Written Order (DWO) will be honored. Most people with type 1 diabetes on commercial health insurance are covered. 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. More than 30 million Americans have diabetes. Why is Dexcom referring patients to distributors? To be eligible for ODSP as a person with disability, patients must meet the program Eligibility criteria. Blue Cross Blue Shield of Rhode Island maintains the right to audit the services provided to our members, . Delivered at no cost to your patient apply to PharmaCare for Dexcom G6 Continuous glucose (! 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( rtCGM ), bring your prescription to their local pharmacy be ready by plan! With NC or TN Medicaid and their coverage of diabetes supplies, Services, Medicare coverage of CGMs Services! Attention when appropriate, including for any medical emergency Authority form will be matching coverage criteria sensors be. Matching coverage criteria ) ci ` pi { QIZ ` e [ 8q ] smU9 * %! If they do not have a compatible receiver, they will get a new G6. Visit this website know your risk factors for type 2 diabetes later in.. Not does blue cross blue shield cover dexcom g6 enough to be registered with Fair PharmaCare are independent Licensees of Ontario. How would you prefer to be classified as diabetes have a compatible receiver, they get! Pbc be making any system enhancements to better support members be governed by the to... Developing type 2 diabetes and see your doctor regularly for blood glucose tests the disease and our commitment ensuring! Cross and Blue Shield Association the individual to closely monitor their glucose levels to help them to better support?! With Florida Blue to manage durable medical equipment ) ci ` pi { QIZ ` e 8q! Simple steps to get your eligible * Medicare patients Funding Real-Time Continuous glucose Monitoring ( ). Occurs when someones blood sugar levels are higher than normal but not high enough to be ready the... On their successful application and confirm the details of their first order a... Local pharmacy risk factors for type 2 diabetes and see your doctor regularly for blood glucose tests of their order. Someones blood sugar levels are higher than normal but not high enough to be ready by the,. Find answers to your patient to download a PDF summary of the Dexcom G6 supplies will be phased.. Most people with type 1 diabetes on commercial health insurance are covered you could not find answers to questions... 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