stream 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. The Dexcom G6 devices offers a similar member experience to the FreeStyle Libre 2 system. A copy of the front and back of your insurance card. Dexcom respects <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> endobj Click here to download a printable PDF copy of the ADP Application for Funding Real-Time Continuous Glucose Monitoring System (rtCGM). Patients can expect their ADP assessment to take approximately 2-3 weeks after the submission of their application form. I have used dexcom for over 10 years, dozens of different policies and never denied! 4 0 obj Everyones health insurance plan is different. Standard and Basic Option members with diabetes can earn rewards through our Diabetes Management Incentive Program. If you have prediabetes, there is a chance, with diet and exercise changes, that you can stop your bodys progression to fully diagnosed diabetes. Diabetes occurs when your body is unable to use sugar in the blood. This plan uses a Preferred Drug List (PDL). Thats about one in every 10 adults. Freestyle Libre 2 offers customizable alarms for users. Prediabetes occurs when someones blood sugar levels are higher than normal but not high enough to be classified as diabetes. These products are covered by U.S. patent. 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. *28zVe +2a$ V Once approved, bring your prescription to your local pharmacy. Prescribers should follow the new patient prescription process. the privacy and confidentiality of your personal information. 0!o!eg[Z'K'xt[ Please review the terms of use and privacy policies of the new site you will be visiting. 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. Covered by MedicareWith expanded coverage for CGM, the Dexcom G6 ContinuousGlucose Monitoring (CGM) System is accessible for more of yourMedicare patients* than ever before. 1 deadbodyswtor 1 yr. ago Depends on the plan. Some people have diabetes without showing any signs or symptoms in the early stages. ( OVtN Step 1: Ask your doctor to e-prescribe your Dexcom CGM supplies to your local pharmacy and to confirm coverage with your pharmacist. Customer Service: 1-844-832-1810 Mon-Fri 9am-8pm EST. &y/Brb4L xDAs?3t%Nufg|{CRt-Jm6lN(+/.}NX[oP4i*V }"WI"+i\mQb}d*W.i}H For more patient-focused information, please visit: Sign up to stay up to date with the latest CGM news, product updates and educational events. 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. 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. 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. 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. Pacific Blue Cross members must now apply to PharmaCare for Dexcom G6 CGM coverage. If a current Dexcom G6 patient ages into Medicare eligibility (i.e., turns 65), they will be treated as a new patient. Learn more here. If you are a healthcare provider and want to learn more about Dexcom, If rejected, Dexcom will notify the patient of their unsuccessful application and discuss their options moving forward. 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 . 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. Qualified individuals for the ADP funding will receive 100% coverage for their Dexcom G6. 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). What if the patients claim is denied at the distributor? Diabetes Management Incentive Program. Also, many Medicare beneficiaries have secondary insurance that covers their copayment. 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. If your glucose alerts and readings from the Dexcom CGM do not match symptoms, use a blood glucose meter to make diabetes treatment decisions. 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. and Dexcom CLARITY are registered trademarks of Dexcom, Inc. in the U.S. and may be in other countries. Your prescriber can complete the Special Authority Request. Contact your primary care provider or diabetes specialist to initiate the Special Authority approval process and to request a prescription for the Dexcom G6 CGM. Currently, CGM system sensors can be used 3-90 days before replacement. Personal CGM systems can exist as a stand-alone system or integrated with an insulin pump. The process for Pacific Blue Cross members to obtain coverage of the Dexcom G6 CGM is changing. endobj 3 yr. ago. Ann Intern Med. Dexcom G4 Platinum A9277 Prior authorization is required. 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. Follow these two simple steps to get your eligible* Medicare patients quickly started on Dexcom G6. These companies are Independent Licensees of the Blue Cross and Blue Shield Association. Please note: Information provided with the sample request is validated against Provider's license information. Individual private insurance plans may differ and are subject to change. <>>> Cookie Notice BC PharmaCare diabetes supplies coverage and eligibility. 1 0 obj I live outside of BC. With expanded coverage for CGM, the Dexcom G6 Continuous, Glucose Monitoring (CGM) System is accessible for more of your. 2023 Dexcom, Dexcom G6, Dexcom G5 Mobile, Dexcom G4, Dexcom Follow and Dexcom CLARITY, Dexcom Share, Share are registered trademarks of Dexcom, Co. in the U.S., and may be registered in other countries. Yes. LBL017680 Rev004. F 9Y|wr~;$PTAGC>:2CH!F&Qq& This is the most common type of diabetes. EN Canada Language English franais Change Country. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. All Dexcom G6 CGM purchases covered by BC PharmaCare need to be made at your pharmacy. Pacific Blue Cross will align coverage duration with PharmaCare. My endo thankfully jumped through the hoops and now mine is 100% covered. 2021;27(6):505-537. 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. All rights reserved. Medicare G6 HCP site -provider.dexcom.com/medicare On June 11, 2021, the Government of British Columbia announced that the Dexcom G6 CGM is now covered through BC PharmaCare for eligible British Columbians. 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. 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. https://www.dexcom.com/safety-information, Use an insulin pump or take 3 daily administrations of insulin, Have an insulin treatment regimen that requires frequent adjustments based on BGM or CGM testing results, Visited your clinic in person to evaluate their diabetes control and you determine that the above criteria have been met within six months prior to ordering the CGM, Have visited your clinic in person to assess adherence to their CGM regimen and diabetes treatment plan every six months. How long will I be covered for the Dexcom G6? If they do not have a compatible receiver, they will get a new Dexcom G6 receiver. Health insurance is offered by Florida Blue. We use cookies on this website to give you the best experience and measure website usage. The process for Pacific Blue Cross members to obtain coverage of the Dexcom G6 CGM is changing. WTF!!!! Click here for important updates on coverage and purchase options. 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. This applies for both new prescriptions and refills. What patient information is required within chart notes to ensure eligibility along with CMS Medicare coverage criteria? However, having it gives you a greater chance of developing type 2 diabetes later in life. <> Once approved, where do I purchase the Dexcom G6? What is Continuous Glucose Monitoring (CGM)? Proven clinical outcomes. If approved, your initial BC PharmaCare Special Authority approval period is valid for one year. How can HCPs prescribe Dexcom G6 to their Medicare patients? The protection of your privacy will be governed by the privacy policy of that site. Non-invasive CGM and related supplies are considered experimental/investigational, and therefore, non-covered because the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature. and our ;caDoOF4R[6HGl^G`@oYlg#(Q0@pa6RH Hi guys! Check your member profile to see if the Dexcom G6 CGM is a benefit under your Pacific Blue Cross plan. By choosing to request info, you are granting Dexcom, Inc. 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. %PDF-1.5 The patient/family/caregiver agrees to comprehensive and age-appropriate diabetes education by an interdisciplinary diabetes healthcare team and commits to regular follow-up. A patient must call their plan to confirm that the distributor is in their network. 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. here. CGM systems consist of a sensor, transmitter and receiver. Heres everything you need to know about it. Error: Please enter a valid email address. As far as I understand it, Dexcom is covered by your pharmacy benefit, not through Anthem. Coverage is subject to the specific terms of the members benefit plan. 2019;21(3):128-132. information and promotional communications related to Dexcom products. N?[;IR. E~"*`xne@? 6 Grunberger G, et al. The PDL is a list showing the drugs that can be covered by the plan. This process . Reddit and its partners use cookies and similar technologies to provide you with a better experience. 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. They simply complete a. You should confirm that the request has been approved before bringing the prescription to their local pharmacy. Florida Blue HMO, an afliate of Florida Blue. Fargo, N.D., 58121. 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