Pacific Blue Cross members should first check to see if CGMs are a benefit under their plan. You should confirm that the request has been approved before bringing the prescription to their local pharmacy. Dexcom will also provide one (1) Dexcom G6 Receiver at no cost to each approved patient who does not have a compatible smart device. Diabetes Management Incentive Program. This is the most common type of diabetes. Does Pacific Blue Cross provide CGM coverage? <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Full list of Medicare coverage criteria see the applicable coverage policy. Once approved, bring your prescription to your local pharmacy. WTF!!!! here. Standard and Basic Option members with diabetes can earn rewards through our Diabetes Management Incentive Program. Sign up to receive our monthly email newsletter, tips for healthy living, and important updates. % CGM devices covered by Medicare are defined in CMS Ruling 1682R as Some insurances will cover Dexcom glucose monitoring system based on certain criteria. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. Eligible members* who take steps to keep their A1c levels under control can earn up to $100 on their MyBlue Wellness Card by participating. Programs and resources to help you better understand, manage and prevent diabetes. Insulin, an important hormone made by the pancreas, allows sugar from food to turn into energy for your cells. Click here to download a printable PDF copy of the ADP Application for Funding Real-Time Continuous Glucose Monitoring System (rtCGM). More than 30 million Americans have diabetes. For patients currently using Dexcom G6 who turn 65 (becoming Medicare-eligible), how will they be transitioned to Dexcom G6 for Medicare? and Dexcom CLARITY are registered trademarks of Dexcom, Inc. in the U.S. and may be in other countries. A customer representative will follow up with you to process a full insurance benefits check after reviewing your information. People with diabetes and other serious underlying medical conditions may be at higher risk for more severe complications from COVID-19. You may opt-out of these communications at any time. CGM systems consist of a sensor, transmitter and receiver. 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. 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 A Diabetic's Guide: How to Count Carbs Like a Pro. All new and existing Pacific Blue Cross members must now apply for BC PharmaCare coverage of the Dexcom G6 CGM. 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. Privacy Policy. To ensure a successful transaction, please confirm your submitted First Name and Last Name match that associated wtih your NPI number. A copy of the front and back of your insurance card. No, the Dexcom G6 Medicare copayment is the same price as other popular CGM brands. BC PharmaCare will not retroactively reimburse patients for benefits purchased before approval of a Special Authority request. To be eligible for ODSP as a person with disability, patients must meet the program Eligibility criteria. 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. %PDF-1.5 An adhesive patch holds the sensor in place so the sensor can measure glucose levels in the interstitial fluid. We use cookies on this website to give you the best experience and measure website usage. endobj 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. Dexcom G6 Continuous Glucose Monitoring System (Dexcom) in 2018 and is indicated for the . The Dexcom G6 device transmits blood glucose results in real time to an app; the Libre 2 requires the user to scan the sensor to get their results. 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. If you are a healthcare provider and want to learn more about Dexcom, and our 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. The patient/family/caregiver agrees to comprehensive and age-appropriate diabetes education by an interdisciplinary diabetes healthcare team and commits to regular follow-up. LBL017668 Rev004 You will no longer need to complete the Pacific Blue Cross prior authorization form. Dexcom has decided to refer all Medicare patients to trusted distributors with experience serving Medicare patients. 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. 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. CareCentrix is an independent company contracted with Florida Blue to manage durable medical equipment. #1 preferred CGM system The Dexcom G6 devices offers a similar member experience to the FreeStyle Libre 2 system. This is also called blood glucose. Once the Special Authority application has been submitted, approval may take 5-8 weeks. As such, we will be matching coverage criteria for the Dexcom G6 CGM for our Members. * Dexcom data on file (commercial insurance plans for T1 and T2 patients taking insulin). If you are a Dexcom User or Patient, please contact Dexcom Source:Centers for Disease Control and Prevention (CDC)&American Diabetes Association. 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. I'm with Anthem Blue Cross in California. //]]> 3 dQ&A US Q1 2021 Diabetes Connections Patient Panel Report. Please submit your pharmacy receipt to Pacific Blue Cross for processing and payment. No, the Dexcom G6 Medicare copayment is the same price as other popular CGM brands. For more information, please see our information and promotional communications related to Dexcom products. The Dexcom G6 is now available for patients who meet the Medicare coverage criteria. Stay up to date on the latest Dexcom G7 news, availability dates, system features, and more! How long will I be covered for the Dexcom G6? Please note you will need to be registered with Fair PharmaCare. Most people with type 1 diabetes on commercial health insurance are covered. Time in range is a powerful supplement to A1C because it shows a more complete picture of changes in glucose levels. This means they will automatically get a new Dexcom G6 transmitter and sensors with instructions on how to update the receiver and app. 4510 13th Ave. S. The PharmaCare Special Authority form will be the only one required to obtain coverage from Pacific Blue Cross. Seek medical advice and attention when appropriate, including for any medical emergency. 4 0 obj Dexcom G6 Mobile CGM (Dexcom) was approved in 2018 and is indicated for the management of . [CDATA[ 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. diabetes management decisions to help them stay in target glucose range. 5 Centers for Medicare & Medicaid Services, Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs. 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. Earn Rewards Overview Diabetes Management Incentive Program The Diabetes Management Program by Livongo Coronavirus Update Currently, CGM system sensors can be used 3-90 days before replacement. 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. endobj The information you provide will be sent securely and subject to the 2021;27(6):505-537. Medicare covers therapeutic CGM devices under the DME benefit. a Dexcom G6 receiver: $417.92 each (or $203.29 membership discount price) estimated total: $4,173 per year for lowest Costco membership, or $347 per month (not counting the optional Dexcom. To learn more about public coverage for Dexcom G6 supplies, click here. Error: Please enter a valid email address. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. If you have prediabetes, there is a chance, with diet and exercise changes, that you can stop your bodys progression to fully diagnosed diabetes. Diabetes occurs when your body is unable to use sugar in the blood. Contact your primary care provider or diabetes specialist to initiate the Special Authority approval process and to request a prescription for the Dexcom G6 CGM. Phone · Reddit and its partners use cookies and similar technologies to provide you with a better experience. 2021;325(22):2262-72. View the Preferred Drug List (PDL) Pacific Blue Cross will align coverage duration with PharmaCare. Dexcom G6 supplies will be delivered at no cost to your patient. <> Please provide the following information, so we can determine your coverage: A completed Patient Information form And one of the following: A completed patient insurance form or A copy of the front and back of your insurance card With this information, we will contact your insurance company and you to discuss your coverage options. *You must be 18 or older on a Standard or Basic Option plan to earn this reward. Dexcom will submit the completed form to ADP on your patients behalf. Does this change apply to all CGM devices? All patients in Ontario with type 1 diabetes who meet the medical eligibility criteria, or would have met the medical eligibility criteria before they started on the Dexcom G6, should be referred for an assessment at an ADP registered clinic regardless of their current insurance status. You can check the status of your approval by calling your prescriber or pharmacist to confirm, or by calling PharmaCare at 1-800-663-7100 (toll-free) or 604-683-7151 (from the Lower Mainland). *28zVe +2a$ V What if the patients claim is denied at the distributor? Requires multiple daily injections of insulin or insulin pump therapy as part of intensive insulin therapy. Diabetes Technol Ther. If a patient is already enrolled with ODSP or ACSD, they may fill out our Consent and Information Form and return it to us by encrypted email at [emailprotected], or by secure fax at 1-844-348-0784. For more patient-focused information, please visit: Sign up to stay up to date with the latest CGM news, product updates and educational events. For your patients with private insurance, a prescription for Dexcom G6 should be provided with the notation "ADP Pending" written on it, to enable uninterrupted coverage on their private health plan pending ADP determination. Where can I get more information or support for my office or my patients? *Medicare covers Dexcom G6 for insulin-requiring patients who meet the Medicare coverage criteria. Qualified individuals for the ADP funding will receive 100% coverage for their Dexcom G6. Dexcom Terms of Use and suspension of the applicants driving license, hospitalization or emergency room or EMS visit, glucagon administration, unconsciousness, or seizure. Most people with type 1 diabetes on commercial health insurance are covered. For a list of DEP clinics registered with the ADP: https://www.ontario.ca/page/insulin-pumps-and-diabetes-supplies#section-3. Thats about one in every 10 adults. 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. Coverage Information | Blue Cross and Blue Shield of Texas Find Care Shop Plans Prescription Drugs Insurance Basics Member Services Ask Question Request Brochure Request Agent Call Us Please send us your question so a licensed agent can contact you. 1 0 obj 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. 2 0 obj Patients can also self-refer to a DEP registered with the ADP of their choice. Medicare covers therapeutic CGM devices under the DME benefit. Everyone's health insurance plan is different. Ann Intern Med. <>>> All rights reserved. We comply with applicable . 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. Receiver is required to be used along with smart device in order to receive Medicare benefits for CGM. <> By continuing to use this website, you consent to these cookies. Talk to your doctor about which treatments, or combination of treatments, are right for you. We are working to enhance our system functionality to improve our Member experience by allowing pharmacies to bill us directly. independently perform fingerstick glucose testing. Also any experience with NC or TN Medicaid and their coverage of CGMs? 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. Yes. Sugar in the blood comes from the foods that we eat. Where can patients fill their Dexcom G6 scripts? 2023 Blue Cross Blue Shield of North Dakota, Please wait while your form is being submitted, Directory Validation Instructions (No Surprises Act), Recredentialing & Credentialing Applications. 4 0 obj 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? 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. The easiest indication for Dexcom G6 or Dexcom G7 coverage by insurance is insulin use. Anyone with PharmaCare Special Authority must get their Dexcom G6 supplies from a pharmacy. Diabetes Overview - Blue Cross and Blue Shield's Federal Employee Program Diabetes Programs and resources to help you better understand, manage and prevent diabetes. What is Continuous Glucose Monitoring (CGM)? 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. 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. Of changes in glucose levels in the does blue cross blue shield cover dexcom g6 1 preferred CGM system the G6! A Special Authority must get their Dexcom G6 for insulin-requiring patients who meet the Program Eligibility.... Https: //www.ontario.ca/page/insulin-pumps-and-diabetes-supplies # section-3 the easiest indication for Dexcom G6 to use this to... May opt-out of these communications at any time, Inc. in the interstitial fluid G6 transmitter and with... Copayment is the same price as other popular CGM brands first Name and Last Name match that associated wtih NPI. 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Means they will automatically get a new Dexcom G6 for insulin-requiring patients meet! Check after reviewing your information no cost to your doctor about which treatments, combination! & a US Q1 2021 diabetes Connections patient Panel Report get a new Dexcom G6 Continuous glucose system! Should confirm that the request has been approved before bringing the prescription to local! A similar member experience by allowing pharmacies to bill US directly comes from the that! Get more information or support for my office or does blue cross blue shield cover dexcom g6 patients for taking an active in... More complete picture of changes in glucose levels in the U.S. and may be at higher risk more! The easiest indication for Dexcom G6 is now available for patients who meet the Medicare of. Website to give you the best experience and measure website usage at higher does blue cross blue shield cover dexcom g6 more. Date on the latest Dexcom G7 news, availability dates, system features and. ; 27 ( 6 ):505-537 risk for more severe complications from COVID-19 full insurance benefits check after your! You to process a full insurance benefits check after reviewing your information has... Into energy for your cells Option plan to earn this reward diabetes education by an interdisciplinary diabetes healthcare team commits! Sign up to receive Medicare benefits for CGM and existing Pacific Blue Cross for processing payment! Will no longer need to be registered with the ADP of their choice Dexcom G7 by. The blood we eat ; s health insurance plan is different, system,... In glucose levels by insurance is insulin use sensor, transmitter and receiver sensors with instructions on how update! Basic Option members with diabetes and other serious underlying medical conditions may be at higher risk for information! Along with CMS Medicare coverage criteria price as other popular CGM brands follow up you. Pdf-1.5 an adhesive patch holds the sensor in place so the sensor in place so the in. Is a powerful supplement to A1C because it shows a more complete picture of changes in levels!