Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically. If a member receives coverage through BC PharmaCare, Pacific Blue Cross will coordinate that coverage. This process . F 9Y|wr~;$PTAGC>:2CH!F&Qq& 2021: 65. and Dexcom CLARITY are registered trademarks of Dexcom, Inc. in the U.S. and may be in other countries. *28zVe +2a$ V BC PharmaCare diabetes supplies coverage and eligibility. Replacement is not covered due to loss, negligence or improper use. At least one functional restriction that inhibits the use of blood glucose test strips (BGTS) (e.g., dexterity, mobility, dermatological problems). By choosing to request info, you are granting Dexcom, Inc. Full eligibility criteria can be found below. here. 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. All new and existing Pacific Blue Cross members must now apply for BC PharmaCare coverage of the Dexcom G6 CGM. This is the most common type of diabetes. After that, it may be renewed for five years. For patients currently using Dexcom G6 who turn 65 (becoming Medicare-eligible), how will they be transitioned to Dexcom G6 for Medicare? Applicant demonstrates experience with and commitment to managing blood sugar control and an ability to use rtCGM safely and effectively by all of the following. ]Odx+q]3hzq- r !sDFFHpe~uF6\h6617ML'i/ii>p@F[0AGqn,LMu{aEJMf? 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. Dexcom, Dexcom Clarity, Dexcom Follow, Dexcom One, Dexcom Share, and any related logos and design marks are either registered trademarks or trademarks of Dexcom, Inc. in the United States and/or other countries. The Dexcom G6 is covered by BC PharmaCare. By accepting all cookies, you agree to our use of cookies to deliver and maintain our services and site, improve the quality of Reddit, personalize Reddit content and advertising, and measure the effectiveness of advertising. 1 0 obj 1 deadbodyswtor 1 yr. ago Depends on the plan. <> Your member ID card is your key to using your medical plan benefits. My endo thankfully jumped through the hoops and now mine is 100% covered. We use cookies on this website to give you the best experience and measure website usage. #1 preferred CGM system How can I receive BC PharmaCare and Pacific Blue Cross coverage? Coverage is subject to the specific terms of the members benefit plan. The Dexcom G6 is now available for patients who meet the Medicare coverage criteria. Some people have diabetes without showing any signs or symptoms in the early stages. The ODSP website also contains information on How to apply. 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 All rights reserved. Most of the time, it goes away after your baby is born. For these members, CGMs will only be covered under their pharmacy benefit. 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. 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. Blue Cross & Blue Shield of Rhode Island (BCBSRI) follows the medical necessity criteria from the Centers . stream Pacific Blue Cross supports this change, which will provide British Columbians living with diabetes more options for diabetes management. 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. The Freestyle Libre 2 is not a BC PharmaCare benefit. Freestyle Libre 2 offers customizable alarms for users. 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. <> Pacific Blue Cross will align with BC PharmaCares criteria for Dexcom G6 coverage. Discover how Dexcom G6 can empower your patients to make more informed All Dexcom G6 CGM purchases covered by BC PharmaCare need to be made at your pharmacy. 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. So apparently under NC's State Health Plan (BCBS) CGM supplies are no longer covered. 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. 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. All rights reserved. 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. 3 0 obj Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Does Pacific Blue Cross provide CGM coverage? 2021;325(22):2262-72. Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. Heres everything you need to know about it. Also, many Medicare beneficiaries have secondary insurance that covers their copayment. Time in range is a powerful supplement to A1C because it shows a more complete picture of changes in glucose levels. By continuing to use this website, you consent to these cookies. 2 0 obj 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. The information you provide will be sent securely and subject to the Personal CGM systems can exist as a stand-alone system or integrated with an insulin pump. This is also called blood glucose. 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. * Dexcom data on file (commercial insurance plans for T1 and T2 patients taking insulin). Qualified individuals for the ADP funding will receive 100% coverage for their Dexcom G6. Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. 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. Check out the changes and updates to our plan in 2023. 1310 G Street, N.W. What is Continuous Glucose Monitoring (CGM)? EN Canada Language English franais Change Country. 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. and our The ACSD website also contains information on How to apply. N?[;IR. The Dexcom G6 is indicated for users aged 2 and older while the Libre 2 is indicated for ages 4 and older. The Dexcom G6 devices offers a similar member experience to the FreeStyle Libre 2 system. 2 Seagrove Partners Q1 2021 HCP Perspectives Survey. Dexcom Tech support - 1-844-607-8398 Does Blue Cross Blue Shield cover Tandem and Dexcom supplies? Covered by MedicareWith expanded coverage for CGM, the Dexcom G6 ContinuousGlucose Monitoring (CGM) System is accessible for more of yourMedicare patients* than ever before. I'm wondering if those of you who use Blue Cross Blue Shield are able to get Tandem and Dexcom supplies. Receiver is required to be used along with smart device in order to receive Medicare benefits for CGM. 7 Beck RW, et al. CGM systems consist of a sensor, transmitter and receiver. Cookie Notice I'm with Anthem Blue Cross in California. 9 Martens T, et al. We expect this functionality to be ready by the end of 2021. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Anyone with PharmaCare Special Authority must get their Dexcom G6 supplies from a pharmacy. window.__mirage2 = {petok:"1HofDHLtMxUU5p5OUOWGr1uLsA_KL6zgddtQxlS.9Sg-1800-0"}; 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). 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. By rejecting non-essential cookies, Reddit may still use certain cookies to ensure the proper functionality of our platform. 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. 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. Insulin, an important hormone made by the pancreas, allows sugar from food to turn into energy for your cells. To learn more about public coverage for Dexcom G6 supplies, click here. 2021;27(6):505-537. diabetes management decisions to help them stay in target glucose range. You may opt-out of these communications at any time. <>/Metadata 327 0 R/ViewerPreferences 328 0 R>> If you are a healthcare provider and want to learn more about Dexcom, Everyone's health insurance plan is different. The existing Detailed Written Order (DWO) will be honored. No, the Dexcom G6 Medicare copayment is the same price as other popular CGM brands. How long will I be covered for the Dexcom G6? * The process is simple: Click the link below and fill out the form provided. However, having it gives you a greater chance of developing type 2 diabetes later in life. 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. 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. 2023 Dexcom, Inc. All rights reserved. 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. Dexcom G6 supplies will be delivered at no cost to your patient. 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. aIJ'%d>8odMw|; dK^OpX`BHb <> For more patient-focused information, please visit: Sign up to stay up to date with the latest CGM news, product updates and educational events. 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 Your prescriber can complete the Special Authority Request. Please review the terms of use and privacy policies of the new site you will be visiting. information and promotional communications related to Dexcom products. You will no longer need to complete the Pacific Blue Cross prior authorization form. LBL017680 Rev004. 2019;21(3):128-132. For the full list of Medicare coverage criteria, visit the Centers for Medicare and Medicaid Services website. Dexcom will be phasing out its online store over the next several months. stream endobj * The process is simple: below and fill out the form provided. 2021: 69-72. Glucose results are used by the individual to closely monitor their glucose levels to help them to better self-manage their diabetes. 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]. Follow these two simple steps to get your eligible* Medicare patients quickly started on Dexcom G6. When completing the application, it may be necessary to answer No to the questions in section 2a/2b. 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. HMO coverage is offered by. Yes. 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. No, the Dexcom G6 Medicare copayment is the same price as other popular CGM brands. <>>> 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. %PDF-1.7 4 0 obj · 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). A copy of the front and back of your insurance card. Gestational diabetes develops in some women when they are pregnant. 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). Will my insurance cover the Dexcom CGM System? Dexcom G6 is available at the distributors listed below. To learn more about public coverage for Dexcom G6 supplies, click here. Found below: click the link below and fill out the changes and updates to plan. To A1C because it shows a more complete picture of changes in glucose levels Eastern time form. More about public coverage for Dexcom G6 Medicare copayment is the same price as other popular CGM brands a! 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Store over the next several months * the process is simple: below fill... Right to review and update medical policy is to be used along with smart device in order to Medicare! A BC PharmaCare benefit and eligibility plans for T1 and T2 patients taking insulin ) changes glucose! Medical technology is constantly evolving, and the Company reserves the right to review and medical! The early stages the next several months receive Medicare benefits for CGM, CGMs only! Time, it may be necessary to answer no to the Freestyle Libre 2 is indicated for aged... The questions in section 2a/2b Cross will align with BC PharmaCares criteria for Dexcom G6 Medicare copayment is the price.