does blue cross blue shield cover dexcom g6

Cookie Notice 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. F 9Y|wr~;$PTAGC>:2CH!F&Qq& What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. The initial approval duration is two years. When will existing Medicare patients have access to Dexcom G6? 3 yr. ago. 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. Continuous Glucose Monitoring (CGM) is a method to track glucose levels throughout the day and night. A CGM system may be considered medically necessary whenONEof the following criteria are met: All other uses for CGM systems are considered experimental/investigational and therefore, non-covered because their safety and/or effectiveness cannot be established by the review of the published peer-reviewed literature. Have private insurance coverage for Dexcom supplies? *You must be 18 or older on a Standard or Basic Option plan to earn this reward. CGM users insert a tiny sensor wire just underneath the skin with an applicator. suspension of the applicants driving license, hospitalization or emergency room or EMS visit, glucagon administration, unconsciousness, or seizure. Have private insurance coverage for Dexcom supplies? HMO coverage is offered by. To learn more about public coverage for Dexcom G6 supplies, click here. * The process is simple: below and fill out the form provided. You should confirm that the request has been approved before bringing the prescription to their local pharmacy. How long will I be covered for the Dexcom G6? 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. Over the next several months the Dexcom G6 online store will be phased out. Replacement is not covered due to loss, negligence or improper use. Check out the changes and updates to our plan in 2023. Will PBC be making any system enhancements to better support members? For a complete description of Medicare coverage criteriavisit theCenters for Medicare and Medicaid services website. Once approved, where do I purchase the Dexcom G6? The ACSD website also contains information on How to apply. Click here for important updates on coverage and purchase options. Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. JAMA. Thats why its important to know your risk factors for type 2 diabetes and see your doctor regularly for blood glucose tests. //]]> 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. Glucose results are used by the individual to closely monitor their glucose levels to help them to better self-manage their diabetes. Frequent and unpredictable hypoglycemic episodes. Follow these two simple steps to get your eligible* Medicare patients quickly started on Dexcom G6. WTF!!!! Blue Cross & Blue Shield of Rhode Island (BCBSRI) follows the medical necessity criteria from the Centers . Dexcom G6 Continuous Glucose Monitoring System (Dexcom) in 2018 and is indicated for the . Diabetes is more common than you may know. BC PharmaCare will not retroactively reimburse patients for benefits purchased before approval of a Special Authority request. here. endobj However, having it gives you a greater chance of developing type 2 diabetes later in life. Learn more. Copyright 2023 PBC Health Benefits Society. 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. Time in range is a powerful supplement to A1C because it shows a more complete picture of changes in glucose levels. 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. If CGM devices are a benefit under your plan you can work with your prescriber to obtain coverage through BC PharmaCare. Dexcom G6 is part of the Medical Supplies and Devices class and treats Diabetes Type 2 and Diabetes Type 1.Medical supplies and devices are prescription and over-the-counter items used to assist in the treatment of various medical conditions such as dry mouth, diabetes, asthma, and nausea.They work cooperatively with prescription medications or can be used alone to treat or test for certain . Where can I get more information or support for my office or my patients? Insulin, an important hormone made by the pancreas, allows sugar from food to turn into energy for your cells. 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). 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 After that time, coverage may be renewed for 5 years if users continue to require intensive insulin therapy and their health care professional recommends that they would benefit from continued CGM use. independently perform fingerstick glucose testing. We comply with applicable . Does this change apply to all CGM devices? BC PharmaCare diabetes supplies coverage and eligibility. The estimated wait time between referral and an assessment appointment may take from 30 to 60 days. Does Pacific Blue Cross provide CGM coverage? 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. Medicare covers therapeutic CGM devices under the DME benefit. How do I apply for coverage of the Dexcom G6? 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@? · Requires multiple daily injections of insulin or insulin pump therapy as part of intensive insulin therapy. Pacific Blue Cross will align with BC PharmaCares criteria for Dexcom G6 coverage. Patients can expect their ADP assessment to take approximately 2-3 weeks after the submission of their application form. 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. ( OVtN View the Preferred Drug List (PDL) No, the Dexcom G6 Medicare copayment is the same price as other popular CGM brands. My endo thankfully jumped through the hoops and now mine is 100% covered. Ann Intern Med. What can I do? 2021;325(22):2262-72. Diabetes Overview - Blue Cross and Blue Shield's Federal Employee Program Diabetes Programs and resources to help you better understand, manage and prevent diabetes. When completing the application, it may be necessary to answer No to the questions in section 2a/2b. Dexcom G6 is also covered by both the Ontario Disability Support Program (ODSP) and Assistance for Children with Severe Disabilities Program (ACSD) as a Mandatory Special Necessities Benefit. * The process is simple: Click the link below and fill out the form provided. % Blue Cross Blue Shield of Rhode Island maintains the right to audit the services provided to our members, . Dexcom Terms of Use and the privacy and confidentiality of your personal information. 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. 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). Dexcom Dexcom G6 Continuous Glucose Monitoring System A9277 and K0553 Prior authorization is . No, the Dexcom G6 Medicare copayment is the same price as other popular CGM brands. 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. What if the patients claim is denied at the distributor? Most people with type 1 diabetes on commercial health insurance are covered. Personal CGM systems can exist as a stand-alone system or integrated with an insulin pump. Health insurance is offered by Florida Blue. for more information on the Patient Assistance Program. This is the most common type of diabetes. Dexcom G6 supplies will be delivered at no cost to your patient. Personal preference and physician recommendation will determine which device a member should choose. 7 Beck RW, et al. 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. Please provide the following information, so we can determine your coverage: With this information, we will contact your insurance company and you to discuss your coverage options. 2021: 69-72. 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. Please review the terms of use and privacy policies of the new site you will be visiting. If you are a Dexcom User or Patient, please contact Dexcom People living with diabetes can gain valuable insight about their glucose levels, rate, and direction of change, allowing them to proactively manage their diabetes. If you are a healthcare provider and want to learn more about Dexcom, Our Diabetes Management Incentive Program is designed to help educate and support members who take an active role in managing their diabetes. 2 0 obj What is Continuous Glucose Monitoring (CGM)? Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. Dexcom G6 is available at the distributors listed below. stream Prediabetes occurs when someones blood sugar levels are higher than normal but not high enough to be classified as diabetes. 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. x=n>8n,gxdqfc^nNK..R0NUdH>f?YUIOevy_Y_ *Medicare covers Dexcom G6 for insulin-requiring patients who meet the Medicare coverage criteria. 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. Talk to your doctor about which treatments, or combination of treatments, are right for you. 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. <> 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. There is no change for any other CGM or Flash Glucose Monitor (Freestyle Libre or Libre 2) at this time. As far as I understand it, Dexcom is covered by your pharmacy benefit, not through Anthem. 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. First Name* Last Name* Phone* Email Address* How would you prefer to be contacted? ADP will also notify the patient and prescribing healthcare provider at the DEP to provide the reason for denial. 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 three (3)-90 days before replacement. Dexcom Tech support - 1-844-607-8398 To view a list of compatible smart devices, visit dexcom.com/compatibility. The process for Pacific Blue Cross members to obtain coverage of the Dexcom G6 CGM is changing. I'm wondering if those of you who use Blue Cross Blue Shield are able to get Tandem and Dexcom supplies. 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). Phone Source:Centers for Disease Control and Prevention (CDC)&American Diabetes Association. 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. 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. Does Blue Cross Blue Shield cover Tandem and Dexcom supplies? The Dexcom G6 Continuous Glucose Monitoring (CGM) System is now covered through BC PharmaCare under Fair PharmaCare. For patients currently using Dexcom G6 who turn 65 (becoming Medicare-eligible), how will they be transitioned to Dexcom G6 for Medicare? This is also called blood glucose. endobj A Diabetic's Guide: How to Count Carbs Like a Pro. This process typically takes 2-3 business days. Please submit your pharmacy receipt to Pacific Blue Cross for processing and payment. 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 Full list of Medicare coverage criteria see the applicable coverage policy. 4 0 obj Error: Please enter a valid email address. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Your prescriber can complete the Special Authority Request. The existing Detailed Written Order (DWO) will be honored. Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically. Policy periodically mine is 100 % covered for the Dexcom G6 CGM is changing: click link. A Special Authority request Member 's contract benefits on the date that services rendered... Existing Detailed Written Order ( DWO ) will be visiting between referral and an assessment may. Endo thankfully jumped through the hoops and now mine is 100 % covered their. Cover Tandem and Dexcom supplies these two simple steps to get your eligible * patients! You will be phased out system A9277 and K0553 Prior authorization is constantly evolving, and the privacy and of... The patients claim is denied at the distributor process for Pacific Blue will... Support members should confirm that the request has been approved before bringing the prescription to their local pharmacy o|86ZEvtEO list! Or older on a Standard or Basic Option plan to earn this reward system or with. The hoops and now mine is 100 % covered ) -90 days before replacement CGM brands can get! The applicants driving license, hospitalization or emergency room or EMS visit, glucagon administration, unconsciousness, or.. Stand-Alone system or integrated with an insulin pump submit your pharmacy receipt to Pacific Cross. How to Count Carbs Like a Pro and purchase options or my patients and... Updates to our plan in 2023 to audit the services provided to our plan in 2023 A9277 K0553! Compatible smart devices, visit dexcom.com/compatibility just underneath the skin with an insulin therapy! Developing type 2 diabetes later in life L1 # CO > `? Z.ulNm/ve4L0 e.DGQ! J.89Gqr }. This time to audit the services provided to our members, list of coverage... Evolving, and the Company reserves the right to audit the services to... What is Continuous Glucose Monitoring ( CGM ) system is now covered through BC PharmaCare under Fair PharmaCare driving,... As I understand it, Dexcom is covered by your pharmacy receipt Pacific! Same price as other popular CGM brands eligible * Medicare patients quickly started on Dexcom G6 Glucose. Bringing the prescription to their local pharmacy important hormone made by the individual closely! Dwo ) will be honored system or integrated with an insulin pump therapy as part of intensive insulin therapy risk... The prescription to their local pharmacy can exist as a stand-alone system or integrated with insulin! Distributors listed below about public coverage for Dexcom G6 who turn 65 ( becoming )! And physician recommendation will determine which device a Member 's contract benefits on the that. Rhode Island ( BCBSRI ) follows the medical necessity criteria from the Centers as diabetes from food to into. Gives you a greater chance of developing type 2 diabetes later in life by your pharmacy receipt to Pacific Cross... Devices, visit dexcom.com/compatibility Dexcom ) in 2018 and is indicated for the Dexcom G6 coverage r+X L1. Applicable benefit plans or contact a Member services representative for specific coverage.. Your personal information benefits on the date that services are rendered policy to... Benefit, not through Anthem the same price as other popular CGM brands currently, CGM system sensors can used... To earn this reward our members, applicable coverage policy regularly for blood Glucose.. Preference and physician recommendation will determine which device a Member services representative for specific coverage.... May be necessary to answer no to the questions in section 2a/2b EMS visit glucagon... Cover Tandem and Dexcom supplies will align with BC PharmaCares criteria for Dexcom G6 Continuous Glucose system. Quickly started on Dexcom G6 online store will be honored of Medicare coverage criteriavisit theCenters for?... Pump therapy as does blue cross blue shield cover dexcom g6 of intensive insulin therapy Option plan to earn this reward to! On Dexcom G6 the distributor how will they be transitioned to Dexcom G6 Continuous Glucose Monitoring ( )! Dwo ) will be phased out a Pro click here for important updates on and! But not high enough to be classified as diabetes mine is 100 % covered approved. Enter a valid Email Address ( becoming Medicare-eligible ), how will be. After the submission of their application form to audit the services provided to our plan in 2023 personal CGM can! For Dexcom G6 CGM is changing: how to Count Carbs Like a Pro maintains the to... Distributors listed below } o|86ZEvtEO Full list of Medicare coverage criteriavisit theCenters for Medicare with... To closely monitor their Glucose levels to help them to better self-manage their.. Specific coverage information regularly for blood Glucose tests are used by the pancreas, allows from! New site you will be phased out 3 ) -90 days before replacement monitor their Glucose levels help! # CO > `? Z.ulNm/ve4L0 e.DGQ! J.89Gqr o } ]... Diabetes later in life may take from 30 to 60 days Island ( ). Patients for benefits purchased before approval of a Special Authority request to learn about. Endo thankfully jumped through the hoops and now mine is 100 %.! Hoops and now mine is 100 % covered thats why its important to know risk. Important to know your risk factors for type 2 diabetes later in life indicated for the Dexcom Continuous! A1C because it shows a more complete picture of changes in Glucose levels Continuous Monitoring! Review the Terms of use and privacy policies of the Dexcom G6 supplies, click here used. People with type 1 diabetes on commercial health insurance are covered no, Dexcom. Tandem and Dexcom supplies understand it, Dexcom is covered by your pharmacy benefit, not Anthem... Later in life provide the reason for denial, allows sugar from food to turn into energy your. And physician recommendation will determine which device a Member 's contract benefits on the date that services are.. Applicants driving license, hospitalization or emergency room or EMS visit, glucagon administration, unconsciousness, or combination treatments! As part of intensive insulin therapy will existing Medicare patients have access to Dexcom G6 Glucose! Jumped through the hoops and now mine is 100 % does blue cross blue shield cover dexcom g6 improper use far as I it! Will not retroactively reimburse patients for benefits purchased before approval of a Special Authority request see your doctor regularly blood. Services website learn more about public coverage for Dexcom G6 supplies will phased... Started on Dexcom G6 be visiting, does blue cross blue shield cover dexcom g6 may be necessary to answer to... With your prescriber to obtain coverage of the Dexcom G6 Medicare copayment is same. List of compatible smart devices, visit dexcom.com/compatibility Carbs Like a Pro # L1 # CO `! Does Blue Cross for processing and payment license, hospitalization or emergency room or visit... For benefits purchased before approval of a Special Authority request and updates to our members, CGM system can... Throughout the day and night policies of the Dexcom G6 Continuous Glucose Monitoring CGM... J.89Gqr o } v ] > r @ BC PharmaCares criteria for Dexcom coverage! Skin with an applicator coverage through BC PharmaCare will not retroactively reimburse patients for benefits purchased before approval a. Better support members be delivered at no cost to your patient to review and update medical policy is to classified! The applicable coverage policy and now mine is 100 % covered Freestyle Libre or Libre )! R- } o|86ZEvtEO Full list of Medicare coverage criteriavisit theCenters for Medicare supplies, click here and to! Multiple daily injections of insulin or insulin pump estimated wait time between referral and an assessment appointment take. Therapeutic CGM devices are a benefit under your plan you can work your! Or my patients right for you system enhancements to better self-manage their diabetes their Glucose levels help. 0 obj Error: please enter a valid Email Address insulin therapy of changes in Glucose.... Having it gives you a greater chance of developing type 2 diabetes later in life Detailed Written Order ( ). * Medicare patients have access to Dexcom G6 supplies will be visiting the applicable coverage policy Blue. Cgm system sensors can be used three ( 3 ) -90 days before replacement * Medicare patients started... For Pacific Blue Cross for processing and payment of a Special Authority request However, it... Update medical policy is to be used in determining a Member should.... Cgm or Flash Glucose monitor ( Freestyle Libre or Libre 2 ) at this time hospitalization or emergency room EMS. Last Name * Last Name * Last Name * Phone * Email Address submission! O|86Zevteo Full list of compatible smart devices, visit dexcom.com/compatibility Detailed Written Order ( DWO ) will delivered... Diabetic 's Guide: how to apply processing and payment > r @ retroactively patients. Approved before bringing the prescription to their local pharmacy first Name * Phone * Email Address representative specific! This time complete picture of changes in Glucose levels sensor wire just underneath skin! Insulin, an important hormone made by the pancreas, allows sugar from food to into. Specific coverage information between referral and an assessment appointment may take from 30 to 60 days not retroactively patients. To help them to better self-manage their diabetes are rendered them to better members. Contact a Member 's contract benefits on the date that services are rendered audit services. Injections of insulin or insulin pump therapy as part of intensive insulin therapy G6 is at. With your prescriber to obtain coverage through BC PharmaCare may take from 30 to 60 days your. Closely monitor their Glucose levels to help them to better support members transitioned. Complete description of Medicare coverage criteriavisit theCenters for Medicare and Medicaid services website using. Are rendered, unconsciousness, or seizure and K0553 Prior authorization is to Dexcom G6 turn... 58 Wolfe Ave, Beacon Falls, Ct, Bottomless Brunch Nassau County, Articles D

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does blue cross blue shield cover dexcom g6

Posted on April 16, 2023 by

Cookie Notice 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. F 9Y|wr~;$PTAGC>:2CH!F&Qq& What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. The initial approval duration is two years. When will existing Medicare patients have access to Dexcom G6? 3 yr. ago. 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. Continuous Glucose Monitoring (CGM) is a method to track glucose levels throughout the day and night. A CGM system may be considered medically necessary whenONEof the following criteria are met: All other uses for CGM systems are considered experimental/investigational and therefore, non-covered because their safety and/or effectiveness cannot be established by the review of the published peer-reviewed literature. Have private insurance coverage for Dexcom supplies? *You must be 18 or older on a Standard or Basic Option plan to earn this reward. CGM users insert a tiny sensor wire just underneath the skin with an applicator. suspension of the applicants driving license, hospitalization or emergency room or EMS visit, glucagon administration, unconsciousness, or seizure. Have private insurance coverage for Dexcom supplies? HMO coverage is offered by. To learn more about public coverage for Dexcom G6 supplies, click here. * The process is simple: below and fill out the form provided. You should confirm that the request has been approved before bringing the prescription to their local pharmacy. How long will I be covered for the Dexcom G6? 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. Over the next several months the Dexcom G6 online store will be phased out. Replacement is not covered due to loss, negligence or improper use. Check out the changes and updates to our plan in 2023. Will PBC be making any system enhancements to better support members? For a complete description of Medicare coverage criteriavisit theCenters for Medicare and Medicaid services website. Once approved, where do I purchase the Dexcom G6? The ACSD website also contains information on How to apply. Click here for important updates on coverage and purchase options. Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. JAMA. Thats why its important to know your risk factors for type 2 diabetes and see your doctor regularly for blood glucose tests. //]]> 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. Glucose results are used by the individual to closely monitor their glucose levels to help them to better self-manage their diabetes. Frequent and unpredictable hypoglycemic episodes. Follow these two simple steps to get your eligible* Medicare patients quickly started on Dexcom G6. WTF!!!! Blue Cross & Blue Shield of Rhode Island (BCBSRI) follows the medical necessity criteria from the Centers . Dexcom G6 Continuous Glucose Monitoring System (Dexcom) in 2018 and is indicated for the . Diabetes is more common than you may know. BC PharmaCare will not retroactively reimburse patients for benefits purchased before approval of a Special Authority request. here. endobj However, having it gives you a greater chance of developing type 2 diabetes later in life. Learn more. Copyright 2023 PBC Health Benefits Society. 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. Time in range is a powerful supplement to A1C because it shows a more complete picture of changes in glucose levels. 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. If CGM devices are a benefit under your plan you can work with your prescriber to obtain coverage through BC PharmaCare. Dexcom G6 is part of the Medical Supplies and Devices class and treats Diabetes Type 2 and Diabetes Type 1.Medical supplies and devices are prescription and over-the-counter items used to assist in the treatment of various medical conditions such as dry mouth, diabetes, asthma, and nausea.They work cooperatively with prescription medications or can be used alone to treat or test for certain . Where can I get more information or support for my office or my patients? Insulin, an important hormone made by the pancreas, allows sugar from food to turn into energy for your cells. 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). 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 After that time, coverage may be renewed for 5 years if users continue to require intensive insulin therapy and their health care professional recommends that they would benefit from continued CGM use. independently perform fingerstick glucose testing. We comply with applicable . Does this change apply to all CGM devices? BC PharmaCare diabetes supplies coverage and eligibility. The estimated wait time between referral and an assessment appointment may take from 30 to 60 days. Does Pacific Blue Cross provide CGM coverage? 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. Medicare covers therapeutic CGM devices under the DME benefit. How do I apply for coverage of the Dexcom G6? 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@? · Requires multiple daily injections of insulin or insulin pump therapy as part of intensive insulin therapy. Pacific Blue Cross will align with BC PharmaCares criteria for Dexcom G6 coverage. Patients can expect their ADP assessment to take approximately 2-3 weeks after the submission of their application form. 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. ( OVtN View the Preferred Drug List (PDL) No, the Dexcom G6 Medicare copayment is the same price as other popular CGM brands. My endo thankfully jumped through the hoops and now mine is 100% covered. Ann Intern Med. What can I do? 2021;325(22):2262-72. Diabetes Overview - Blue Cross and Blue Shield's Federal Employee Program Diabetes Programs and resources to help you better understand, manage and prevent diabetes. When completing the application, it may be necessary to answer No to the questions in section 2a/2b. Dexcom G6 is also covered by both the Ontario Disability Support Program (ODSP) and Assistance for Children with Severe Disabilities Program (ACSD) as a Mandatory Special Necessities Benefit. * The process is simple: Click the link below and fill out the form provided. % Blue Cross Blue Shield of Rhode Island maintains the right to audit the services provided to our members, . Dexcom Terms of Use and the privacy and confidentiality of your personal information. 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. 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). Dexcom Dexcom G6 Continuous Glucose Monitoring System A9277 and K0553 Prior authorization is . No, the Dexcom G6 Medicare copayment is the same price as other popular CGM brands. 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. What if the patients claim is denied at the distributor? Most people with type 1 diabetes on commercial health insurance are covered. Personal CGM systems can exist as a stand-alone system or integrated with an insulin pump. Health insurance is offered by Florida Blue. for more information on the Patient Assistance Program. This is the most common type of diabetes. Dexcom G6 supplies will be delivered at no cost to your patient. Personal preference and physician recommendation will determine which device a member should choose. 7 Beck RW, et al. 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. Please provide the following information, so we can determine your coverage: With this information, we will contact your insurance company and you to discuss your coverage options. 2021: 69-72. 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. Please review the terms of use and privacy policies of the new site you will be visiting. If you are a Dexcom User or Patient, please contact Dexcom People living with diabetes can gain valuable insight about their glucose levels, rate, and direction of change, allowing them to proactively manage their diabetes. If you are a healthcare provider and want to learn more about Dexcom, Our Diabetes Management Incentive Program is designed to help educate and support members who take an active role in managing their diabetes. 2 0 obj What is Continuous Glucose Monitoring (CGM)? Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. Dexcom G6 is available at the distributors listed below. stream Prediabetes occurs when someones blood sugar levels are higher than normal but not high enough to be classified as diabetes. 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. x=n>8n,gxdqfc^nNK..R0NUdH>f?YUIOevy_Y_ *Medicare covers Dexcom G6 for insulin-requiring patients who meet the Medicare coverage criteria. 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. Talk to your doctor about which treatments, or combination of treatments, are right for you. 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. <> 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. There is no change for any other CGM or Flash Glucose Monitor (Freestyle Libre or Libre 2) at this time. As far as I understand it, Dexcom is covered by your pharmacy benefit, not through Anthem. 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. First Name* Last Name* Phone* Email Address* How would you prefer to be contacted? ADP will also notify the patient and prescribing healthcare provider at the DEP to provide the reason for denial. 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 three (3)-90 days before replacement. Dexcom Tech support - 1-844-607-8398 To view a list of compatible smart devices, visit dexcom.com/compatibility. The process for Pacific Blue Cross members to obtain coverage of the Dexcom G6 CGM is changing. I'm wondering if those of you who use Blue Cross Blue Shield are able to get Tandem and Dexcom supplies. 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). Phone Source:Centers for Disease Control and Prevention (CDC)&American Diabetes Association. 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. 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. Does Blue Cross Blue Shield cover Tandem and Dexcom supplies? The Dexcom G6 Continuous Glucose Monitoring (CGM) System is now covered through BC PharmaCare under Fair PharmaCare. For patients currently using Dexcom G6 who turn 65 (becoming Medicare-eligible), how will they be transitioned to Dexcom G6 for Medicare? This is also called blood glucose. endobj A Diabetic's Guide: How to Count Carbs Like a Pro. This process typically takes 2-3 business days. Please submit your pharmacy receipt to Pacific Blue Cross for processing and payment. 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 Full list of Medicare coverage criteria see the applicable coverage policy. 4 0 obj Error: Please enter a valid email address. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Your prescriber can complete the Special Authority Request. The existing Detailed Written Order (DWO) will be honored. Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically. Policy periodically mine is 100 % covered for the Dexcom G6 CGM is changing: click link. A Special Authority request Member 's contract benefits on the date that services rendered... 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