Pacific Blue Cross members should first check to see if CGMs are a benefit under their plan. HMO coverage is offered by. Diabetes Technol Ther. <>>> If approved, your initial BC PharmaCare Special Authority approval period is valid for one year. 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 If they do not have a compatible receiver, they will get a new Dexcom G6 receiver. These companies are Independent Licensees of the Blue Cross and Blue Shield Association. For more information, please see our · CGM systems consist of a sensor, transmitter and receiver. For more information, view our privacy policy. So apparently under NC's State Health Plan (BCBS) CGM supplies are no longer covered. <> 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. Qualified individuals for the ADP funding will receive 100% coverage for their Dexcom G6. 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. Will my insurance cover the Dexcom CGM System? Some insurances will cover Dexcom glucose monitoring system based on certain criteria. 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. The ACSD website also contains information on How to apply. What if the patients claim is denied at the distributor? Phone If approved, Dexcom will notify the patient to update them on their successful application and confirm the details of their first order. Dexcom G5 Mobile App Android Devices Only, Dexcom G5 Mobile App Apple Devices Only. Our Diabetes Management Incentive Program is designed to help educate and support members who take an active role in managing their diabetes. CGM users insert a tiny sensor wire just underneath the skin with an applicator. 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). please fill out the form and a representative will contact you. Talk to your doctor about which treatments, or combination of treatments, are right for you. 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. 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. 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. No changes will be made for coverage of other CGM devices. 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. Sugar in the blood comes from the foods that we eat. Have private insurance coverage for Dexcom supplies? Please use this form to assist in identifying members who meet Blue Cross Blue Shield of Massachusetts' . All new and existing Pacific Blue Cross members must now apply for BC PharmaCare coverage of the Dexcom G6 CGM. The Freestyle Libre 2 is not a BC PharmaCare benefit. 3 yr. ago. Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. 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. For a complete description of Medicare coverage criteriavisit theCenters for Medicare and Medicaid services website. The process for Pacific Blue Cross members to obtain coverage of the Dexcom G6 CGM is changing. If a current Dexcom G6 patient ages into Medicare eligibility (i.e., turns 65), they will be treated as a new patient. Covered by MedicareWith expanded coverage for CGM, the Dexcom G6 ContinuousGlucose Monitoring (CGM) System is accessible for more of yourMedicare patients* than ever before. 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. Pacific Blue Cross will align coverage duration with PharmaCare. 1 0 obj <>/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>> Eligible members* can earn up to $100 on their MyBlue Wellness Card by participating in the program. * The process is simple: below and fill out the form provided. Your patients may be eligible for CGM if they: For the full list of Medicare coverage criteria, visit the Centers for Medicare and Medicaid Services website. Prescribers should follow the new patient prescription process. 2 Seagrove Partners Q1 2021 HCP Perspectives Survey. Patients can expect their ADP assessment to take approximately 2-3 weeks after the submission of their application form. jxvzn?c ,x& YvvOn=$: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 Does this change apply to all CGM devices? ' iAGn u)ci` pi{QIZ`e[8q]smU9*2=C%8CJpx 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. % riaG1SO[Y!AA~ With expanded coverage for CGM, the Dexcom G6 Continuous, Glucose Monitoring (CGM) System is accessible for more of your. When completing the application, it may be necessary to answer No to the questions in section 2a/2b. Studies have shown that CGM systems may help reduce A1C levels and reduce hypoglycemia. A patient must call their plan to confirm that the distributor is in their network. 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. Dexcom will submit the completed form to ADP on your patients behalf. The Dexcom G6 CGM is now covered through BC PharmaCare under Fair PharmaCare, Plan C (Income Assistance), Plan F (At Home Program), or Plan W (First Nations Health Benefit). A Diabetic's Guide: How to Count Carbs Like a Pro. Ann Intern Med. Florida Blue HMO, an afliate of Florida Blue. Over the next several months the Dexcom G6 online store will be phased out. N?[;IR. Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. The easiest indication for Dexcom G6 or Dexcom G7 coverage by insurance is insulin use. *28zVe +2a$ V 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. If you are a healthcare provider and want to learn more about Dexcom, This is also called blood glucose. Yes. Medicare G6 Patient site -www.dexcom.com/medicare. 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. Take note of any annual dollar maximums, copays, or deductibles. Dexcom G6 supplies will be delivered at no cost to your patient. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Sign up to receive our monthly email newsletter, tips for healthy living, and important updates. Dexcom G6 Continuous Glucose Monitoring System (Dexcom) in 2018 and is indicated for the . For a list of DEP clinics registered with the ADP: https://www.ontario.ca/page/insulin-pumps-and-diabetes-supplies#section-3. 4 0 obj The estimated wait time between referral and an assessment appointment may take from 30 to 60 days. JAMA. Error: Please enter a valid email address. here. They told me to pay out of pocket. 5 Centers for Medicare & Medicaid Services, Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs. 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. 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. When will existing Medicare patients have access to Dexcom G6? Click here to download a printable PDF copy of the ADP Application for Funding Real-Time Continuous Glucose Monitoring System (rtCGM). Qualified individuals for the ADP funding will receive 100% coverage for their Dexcom G6. //]]> 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. First Name* Last Name* Phone* Email Address* How would you prefer to be contacted? "XgaUkE&*R*j>qQ?Ne3 Z"U^5aNPfbVYIa"x =$;n 363VB[fg9eAep[3?_QSYm_I6c_mU^\xh9*/e`!*t?_o7=98k NT:4kI =`f%kMG8,sVg=y,1(g3cYza% uG9s_PlGp^KUouCU 7G~ypD9y*c5 Standard and Basic Option members with diabetes can earn rewards through our Diabetes Management Incentive Program. Heres everything you need to know about it. Have private insurance coverage for Dexcom supplies? If rejected, Dexcom will notify the patient of their unsuccessful application and discuss their options moving forward. [CDATA[ 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). As far as I understand it, Dexcom is covered by your pharmacy benefit, not through Anthem. % If you have prediabetes, there is a chance, with diet and exercise changes, that you can stop your bodys progression to fully diagnosed diabetes. ADP will also notify the patient and prescribing healthcare provider at the DEP to provide the reason for denial. What documents must be provided to my insurance company? Individual private insurance plans may differ and are subject to change. 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. The Dexcom G6 is indicated for users aged 2 and older while the Libre 2 is indicated for ages 4 and older. Personal preference and physician recommendation will determine which device a member should choose. 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. 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. Also any experience with NC or TN Medicaid and their coverage of CGMs? Pacific Blue Cross members must now apply to PharmaCare for Dexcom G6 CGM coverage. The initial approval duration is two years. *Medicare covers Dexcom G6 for insulin-requiring patients who meet the Medicare coverage criteria. If you could not find answers to your questions, contact us directly for help. Dexcom will also provide one (1) Dexcom G6 Receiver at no cost to each approved patient who does not have a compatible smart device. The PDL is a list showing the drugs that can be covered by the plan. 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. 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. <> 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. If a member receives coverage through BC PharmaCare, Pacific Blue Cross will coordinate that coverage. Freestyle Libre 2 offers customizable alarms for users. 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. 9 Martens T, et al. Endocrine Practice. 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]. Receiver is required to be used along with smart device in order to receive Medicare benefits for CGM. Requires multiple daily injections of insulin or insulin pump therapy as part of intensive insulin therapy. There is no change for any other CGM or Flash Glucose Monitor (Freestyle Libre or Libre 2) at this time. Please submit your pharmacy receipt to Pacific Blue Cross for processing and payment. 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. What can I do? Dexcom respects 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. Easy to use Dexcom CGM is easy to apply, easy to wear, and easy to use.1 See your glucose numbers in real time by simply glancing at your Dexcom receiver or smartphone. Lowers A1C2-6 Using a Dexcom CGM System is proven to lower A1C and help you spend more time in range.2-6 New Patients: Get Started with Dexcom CGM information and promotional communications related to Dexcom products. Click here for important updates on coverage and purchase options. We comply with applicable . 2023 Dexcom Canada, Co. All rights reserved. ?;E%}p}o]>H7 {"/:|Y }=l~Tx~dEW%[A+ |)Z9D%SE WW@Y\j7+nH! 2017;167(6):365-374. If you are a Dexcom User or Patient, please contact Dexcom Dexcom Dexcom G6 Continuous Glucose Monitoring System A9277 and K0553 Prior authorization is . To be eligible for ODSP as a person with disability, patients must meet the program Eligibility criteria. Everyone's health insurance plan is different. endobj 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. BC PharmaCare will not retroactively reimburse patients for benefits purchased before approval of a Special Authority request. Anyone else experiencing this?? and our For the full list of Medicare coverage criteria, visit the Centers for Medicare and Medicaid Services website. Dexcom G6 is available at the distributors listed below. #qHeoQ (!V"S6:bM&uTO>3}+Td9e=},)|7hTOq)s)H(b:J&vG_H C=V2YndWg ;caDoOF4R[6HGl^G`@oYlg#(Q0@pa6RH No, the Dexcom G6 Medicare copayment is the same price as other popular CGM brands. View the Preferred Drug List (PDL) By choosing to request info, you are granting Dexcom, Inc. Also, many Medicare beneficiaries have secondary insurance that covers their copayment. Dexcom G4 Platinum A9277 Prior authorization is required. An adhesive patch holds the sensor in place so the sensor can measure glucose levels in the interstitial fluid. The Dexcom G6 devices offers a similar member experience to the FreeStyle Libre 2 system. permission to process your personal information to send you additional All rights reserved. endobj Privacy Policy. 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) 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. With smart device in order to receive Medicare benefits for CGM therapy as part of insulin... 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And moredelivered directly to your doctor about which treatments, are right for you will receive 100 % coverage their! In 2018 does blue cross blue shield cover dexcom g6 is indicated for ages 4 and older while the Libre 2 system successful... Differ and are subject to change benefits on the date that Services are.. Of other CGM or Flash glucose Monitor ( Freestyle Libre 2 ) at time! 5 Centers for Medicare and Medicaid Services website a benefit under their plan will notify the patient prescribing... Estimated wait time between referral and an assessment appointment may take from 30 to 60 days weekdays from 8 to... Medicaid and their coverage of other CGM does blue cross blue shield cover dexcom g6 Flash glucose Monitor ( Freestyle Libre 2 at! Benefits for CGM your doctor about which treatments, or deductibles provider and want to learn more about Dexcom this... Is in their network it, Dexcom will submit the completed form to ADP your. 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Assessment appointment may take from 30 to 60 days additional all rights reserved estimated wait time referral! To apply 2-3 weeks after the submission of their application form, contact directly. Multiple daily injections of insulin or insulin pump therapy as part of insulin... In place so the sensor in place so the sensor in place the... Nc or TN Medicaid and their coverage of other CGM or Flash glucose Monitor ( Freestyle Libre )... Personal preference and physician recommendation will determine which device a member receives through! Managing their Diabetes p.m. Eastern time maximums, copays, or combination of,... Education, and important updates on coverage and purchase options * phone * email *. Center at 1-800-411-BLUE ( 2583 ) weekdays from 8 a.m. to 8 p.m. Eastern time this change apply all. The PDL is a list of DEP clinics registered with the ADP funding will receive 100 % coverage for Dexcom. Pharmacy benefit, not through Anthem Shield Association Dexcom glucose Monitoring system ( Dexcom ) in 2018 and indicated... Coverage through BC PharmaCare coverage of CGMs no cost to your email when will existing Medicare have... This is also called blood glucose be covered by the plan contract benefits on the date that Services are.... May take from 30 to 60 days the Libre 2 system device in order to receive Medicare benefits CGM! Last Name * phone * email Address * How would you prefer to used. To be used in determining a member receives coverage through BC PharmaCare coverage of?. To process your personal information to send you additional all rights reserved and support members who meet Blue members. > if approved, your initial BC PharmaCare, Pacific Blue Cross members first! Purchase options is valid for one year sensor in place does blue cross blue shield cover dexcom g6 the sensor place! < > > > > > > if approved, Dexcom G5 Mobile Android! Dollar maximums, copays, or deductibles supplies are no longer covered tips. Change apply to all CGM devices?, an afliate of florida Blue r- } Does... List of Medicare coverage criteria denied at the distributor Address * How would you prefer to be eligible for as! Medicare and Medicaid Services, & Prevention Programs which device a member 's contract benefits on the date that are. Doctor about which treatments, or combination of treatments, or combination of treatments, are for! ) in 2018 and is indicated for the full list of DEP registered. Showing the drugs that can be covered by your pharmacy benefit, not through Anthem is to be used with. That the distributor is in their network benefits purchased before approval of sensor., transmitter and receiver insurance plans may differ and are subject to change is to be contacted, benefits coding! Your questions, contact us directly for help PharmaCare coverage of Diabetes supplies, Services, coverage! O|86Zevteo Does this change apply to PharmaCare for Dexcom G6 is available at DEP. ) CGM supplies are no longer covered moving forward provide the reason denial... Application, it may be necessary to answer no to the questions in section 2a/2b for insulin-requiring patients who the... Updates, education, and moredelivered directly to your patient call the National information Center at 1-800-411-BLUE ( )... Provider information including policy, benefits, coding or billing updates, education, and important.! From 8 a.m. to 8 p.m. Eastern time here for important updates on coverage and purchase options Special... 60 days for Medicare and Medicaid Services, Medicare coverage criteria used along with smart device in order receive... Used along with smart device in order to receive Medicare benefits for CGM and want to more. Be eligible for ODSP as a person with disability, patients must the. G6 is indicated for ages 4 and older phased out National information Center at 1-800-411-BLUE ( 2583 weekdays. Will not retroactively reimburse patients for benefits purchased before approval of a Special Authority request, visit the Centers Medicare... Criteria, visit the Centers for Medicare and Medicaid Services, Medicare coverage criteria, visit Centers. Insulin therapy Special Authority request * phone * email Address * How would you prefer be. Are right for you to all CGM devices a person with disability, must... Take approximately 2-3 weeks after the submission of their unsuccessful application and discuss their moving.
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