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. The ACSD website also contains information on How to apply. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>>
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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. endobj
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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. 2021;27(6):505-537. Why is Dexcom referring patients to distributors? Studies have shown that CGM systems may help reduce A1C levels and reduce hypoglycemia. Sign up to receive our monthly email newsletter, tips for healthy living, and important updates. 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. 9 Martens T, et al. 2019;21(3):128-132. Diabetes Management Incentive Program. 7E^DPN)0>fe E+gM2^6xX3,o):,`5-ihS,3Ei6^.h,.#=DaSv/ee)w(($2HG\Oz~:P+S~XysQ
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@e^NN(eU. This is also called blood glucose. If a current Dexcom G6 patient ages into Medicare eligibility (i.e., turns 65), they will be treated as a new patient. Currently, CGM system sensors can be used 3-90 days before replacement. 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. Anyone with PharmaCare Special Authority must get their Dexcom G6 supplies from a pharmacy. The Dexcom G6 is covered by BC PharmaCare. You can check the status of your approval by calling your prescriber or pharmacist to confirm, or by calling PharmaCare at 1-800-663-7100 (toll-free) or 604-683-7151 (from the Lower Mainland). 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. 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. g9=_ONozKsifm7k =dk!?j
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Earn Rewards Overview Diabetes Management Incentive Program The Diabetes Management Program by Livongo Coronavirus Update 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. Replacement is not covered due to loss, negligence or improper use. 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. Does Pacific Blue Cross provide CGM coverage? For more information, view our privacy policy. The easiest indication for Dexcom G6 or Dexcom G7 coverage by insurance is insulin use. 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. 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 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. Eligible members* who take steps to keep their A1c levels under control can earn up to $100 on their MyBlue Wellness Card by participating. 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 Dexcom G6 Continuous Glucose Monitoring System (Dexcom) in 2018 and is indicated for the . You will no longer need to complete the Pacific Blue Cross prior authorization form. Dexcom G4 Platinum A9277 Prior authorization is required. Glucose results are used by the individual to closely monitor their glucose levels to help them to better self-manage their diabetes. JAMA. The Dexcom G6 also provides predictive alerts that notify a user when blood sugar is going low up to 20 minutes before it occurs helping those who experience rapidly changing blood glucose levels. 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. <>
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. Most people with type 1 diabetes on commercial health insurance are covered. Coverage is subject to the specific terms of the members benefit plan. 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 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. Stay up to date on the latest Dexcom G7 news, availability dates, system features, and more! Over time, diabetes can increase your risk for serious health conditions, including heart disease, blindness, kidney failure and even amputations. Pacific Blue Cross members should first check to see if CGMs are a benefit under their plan. "XgaUkE&*R*j>qQ?Ne3 Z"U^5aNPfbVYIa"x =$;n
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7G~ypD9y*c5 Dexcom G6 Mobile CGM (Dexcom) was approved in 2018 and is indicated for the management of . 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. aIJ'%d>8odMw|;
dK^OpX`BHb Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. 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. Qualified individuals for the ADP funding will receive 100% coverage for their Dexcom G6. To view a list of compatible smart devices, visit dexcom.com/compatibility. Qi\rj*G[6[:'D1 }+(ll!X3#eno$)RkigF!oy7 hGpO3i"|d3(@!+& 2023 Dexcom, Inc. All rights reserved. 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. Ann Intern Med. To ensure a successful transaction, please confirm your submitted First Name and Last Name match that associated wtih your NPI number. Our Diabetes Management Incentive Program is designed to help educate and support members who take an active role in managing their diabetes. Also, many Medicare beneficiaries have secondary insurance that covers their copayment. Dexcom will also provide one (1) Dexcom G6 Receiver at no cost to each approved patient who does not have a compatible smart device. Error: Please enter a valid email address. diabetes management decisions to help them stay in target glucose range. Requires multiple daily injections of insulin or insulin pump therapy as part of intensive insulin therapy. For these members, CGMs will only be covered under their pharmacy benefit. 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. Individual private insurance plans may differ and are subject to change. They told me to pay out of pocket. 2017;167(6):365-374. #1 preferred CGM system //]]> LBL017680 Rev004. 2 Seagrove Partners Q1 2021 HCP Perspectives Survey. With expanded coverage for CGM, the Dexcom G6 Continuous, Glucose Monitoring (CGM) System is accessible for more of your. independently perform fingerstick glucose testing. #qHeoQ (!V"S6:bM&uTO>3}+Td9e=},)|7hTOq)s)H(b:J&vG_H C=V2YndWg 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. These products are covered by U.S. patent. 6 Grunberger G, et al. 4 0 obj
A customer representative will follow up with you to process a full insurance benefits check after reviewing your information. Pacific Blue Cross members must now apply to PharmaCare for Dexcom G6 CGM coverage. 5 Centers for Medicare & Medicaid Services, Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs. Time in range is a powerful supplement to A1C because it shows a more complete picture of changes in glucose levels. My endo thankfully jumped through the hoops and now mine is 100% covered. For a list of DEP clinics registered with the ADP: https://www.ontario.ca/page/insulin-pumps-and-diabetes-supplies#section-3. 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. 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. 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. 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. 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. These companies are Independent Licensees of the Blue Cross and Blue Shield Association. Medicare covers therapeutic CGM devices under the DME benefit. EN Canada Language English franais Change Country. The existing Detailed Written Order (DWO) will be honored. A Diabetic's Guide: How to Count Carbs Like a Pro. Have private insurance coverage for Dexcom supplies? 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. Since A1C is a three-month average, it doesnt give insight into potentially dangerous high and low glucose variations. Some people have diabetes without showing any signs or symptoms in the early stages. By choosing to request info, you are granting Dexcom, Inc. Learn more. Personal CGM systems can exist as a stand-alone system or integrated with an insulin pump. No changes will be made for coverage of other CGM devices. Thats about one in every 10 adults. 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. The information you provide will be sent securely and subject to the 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. Please review the terms of use and privacy policies of the new site you will be visiting. F 9Y|wr~;$PTAGC>:2CH!F&Qq& If you have prediabetes, there is a chance, with diet and exercise changes, that you can stop your bodys progression to fully diagnosed diabetes. Proven clinical outcomes. 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. 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. 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. 1310 G Street, N.W. Your member ID card is your key to using your medical plan benefits. The Dexcom G6 is now available for patients who meet the Medicare coverage criteria. If approved, your initial BC PharmaCare Special Authority approval period is valid for one year. Dexcom Tech support - 1-844-607-8398 Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically. 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]. 2 0 obj
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Contact Dexcom to get the specific information you will need with your insurance plan as plan requirements vary. 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. * Dexcom data on file (commercial insurance plans for T1 and T2 patients taking insulin). 2021;325(22):2262-72. 2023 Dexcom Canada, Co. All rights reserved. If your glucose alerts and readings from the Dexcom CGM do not match symptoms, use a blood glucose meter to make diabetes treatment decisions. Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. stream
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. and our 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) Dexcom G6 is available at the distributors listed below. CGM systems consist of a sensor, transmitter and receiver. 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. 2022 Dexcom Canada, Co. All rights reserved. For a complete description of Medicare coverage criteriavisit theCenters for Medicare and Medicaid services website. Thats why its important to know your risk factors for type 2 diabetes and see your doctor regularly for blood glucose tests. Freestyle Libre 2 offers customizable alarms for users. Also, many Medicare beneficiaries have secondary insurance that covers their copayment. A small, reusable transmitter connects to the sensor and sends real-time readings wirelessly to a receiver, so users can view the information. 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. If you are a Dexcom User or Patient, please contact Dexcom Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Wednesday, Jul 21, 2021 The Dexcom G6 Continuous Glucose Monitoring (CGM) System is now covered through BC PharmaCare under Fair PharmaCare. ' iAGn u)ci` pi{QIZ`e[8q]smU9*2=C%8CJpx 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. To learn more about public coverage for Dexcom G6 supplies, click here. Source:Centers for Disease Control and Prevention (CDC)&American Diabetes Association. 2019;6. and Dexcom CLARITY are registered trademarks of Dexcom, Inc. in the U.S. and may be in other countries. BC PharmaCare diabetes supplies coverage and eligibility. 1 0 obj
If rejected, Dexcom will notify the patient of their unsuccessful application and discuss their options moving forward. Continuous Glucose Monitoring (CGM) is a method to track glucose levels throughout the day and night. We expect this functionality to be ready by the end of 2021. All Dexcom G6 CGM purchases covered by BC PharmaCare need to be made at your pharmacy. Most people with type 1 diabetes on commercial health insurance are covered. However, having it gives you a greater chance of developing type 2 diabetes later in life. HMO coverage is offered by. What if the patients claim is denied at the distributor? You can call your prescriber or pharmacist to confirm your approval, or call PharmaCare at 1-800-663-7100 (toll-free) or 604-683-7151 (from the Lower Mainland). If approved, Dexcom will notify the patient to update them on their successful application and confirm the details of their first order. Prescribers should follow the new patient prescription process. Phone 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. ( OVtN I have been using G6 for almost a year and insurance has provided coverage up until now and I assume the policy changed because now they no longer do. Seek medical advice and attention when appropriate, including for any medical emergency. Yes. endobj
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Please use this form to assist in identifying members who meet Blue Cross Blue Shield of Massachusetts' . Frequent and unpredictable hypoglycemic episodes. 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. please fill out the form and a representative will contact you. WTF!!!! 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. All rights reserved. *You must be 18 or older on a Standard or Basic Option plan to earn this reward. Programs and resources to help you better understand, manage and prevent diabetes. Click here to download a PDF summary of the Ontario ADP coverage information. information and promotional communications related to Dexcom products. 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