Will PBC be making any system enhancements to better support members? The process for Pacific Blue Cross members to obtain coverage of the Dexcom G6 CGM is changing. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. *Medicare covers Dexcom G6 for insulin-requiring patients who meet the Medicare coverage criteria. ;caDoOF4R[6HGl^G`@oYlg#(Q0@pa6RH Personal CGM systems can exist as a stand-alone system or integrated with an insulin pump. Earn Rewards Overview Diabetes Management Incentive Program The Diabetes Management Program by Livongo Coronavirus Update For a complete description of Medicare coverage criteriavisit theCenters for Medicare and Medicaid services website. Click here to download a PDF summary of the Ontario ADP coverage information. 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. Full list of Medicare coverage criteria see the applicable coverage policy. Anyone with PharmaCare Special Authority must get their Dexcom G6 supplies from a pharmacy. 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. Full eligibility criteria can be found below. and Dexcom CLARITY are registered trademarks of Dexcom, Inc. in the U.S. and may be in other countries. Dexcom G6 Mobile CGM (Dexcom) was approved in 2018 and is indicated for the management of . Diabetes occurs when your body is unable to use sugar in the blood. %PDF-1.7
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and our For more patient-focused information, please visit: Sign up to stay up to date with the latest CGM news, product updates and educational events. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>>
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~. r-}o|86ZEvtEO 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. If you could not find answers to your questions, contact us directly for help. <>/Metadata 327 0 R/ViewerPreferences 328 0 R>>
Blue Cross Blue Shield of Rhode Island maintains the right to audit the services provided to our members, . Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. Discover how Dexcom G6 can empower your patients to make more informed Please note: Information provided with the sample request is validated against Provider's license information. What documents must be provided to my insurance company? x=n>8n,gxdqfc^nNK..R0NUdH>f?YUIOevy_Y_ Dexcom respects %
riaG1SO[Y!AA~ Check out the changes and updates to our plan in 2023. 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. Pacific Blue Cross will align coverage duration with PharmaCare. Personal CGM systems can exist as a stand-alone system or integrated with an insulin pump. Where can patients fill their Dexcom G6 scripts? 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 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. 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. 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. Qi\rj*G[6[:'D1 }+(ll!X3#eno$)RkigF!oy7 hGpO3i"|d3(@!+& Are you a current customer facing financial constraints? 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. 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. Yes. What is Continuous Glucose Monitoring (CGM)? 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. · The existing Detailed Written Order (DWO) will be honored. 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. The process for Pacific Blue Cross members to obtain coverage of the Dexcom G6 CGM is changing. How can HCPs prescribe Dexcom G6 to their Medicare patients? ' iAGn u)ci` pi{QIZ`e[8q]smU9*2=C%8CJpx Once approved, where do I purchase the Dexcom G6? 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. 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. 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. Seek medical advice and attention when appropriate, including for any medical emergency. After that, it may be renewed for five years. %PDF-1.5
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 This plan uses a Preferred Drug List (PDL). 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. To learn more about public coverage for Dexcom G6 supplies, click here. 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. Please note you will need to be registered with Fair PharmaCare. Learn more here. Dexcom Tech support - 1-844-607-8398 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. for more information on the Patient Assistance Program. permission to process your personal information to send you additional Glucose results are used by the individual to closely monitor their glucose levels to help them to better self-manage their diabetes. Everyone's health insurance plan is different. By rejecting non-essential cookies, Reddit may still use certain cookies to ensure the proper functionality of our platform. The Dexcom G6 devices offers a similar member experience to the FreeStyle Libre 2 system. aIJ'%d>8odMw|;
dK^OpX`BHb 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). Medicare G6 HCP site -provider.dexcom.com/medicare The ODSP website also contains information on How to apply. Is the Dexcom G6 Medicare copayment more expensive than for that of other CGM brands? You may have pharmacy coverage for Dexcom through your insurance, which would allow you to get supplies at your local pharmacy. We are working to enhance our system functionality to improve our Member experience by allowing pharmacies to bill us directly. 2019;6. The Diabetes Management Program by Livongo, Centers for Disease Control and Prevention (CDC), Work with a registered dietician to develop a healthy meal plan, Exercise at least 30 minutes a day, 5 days a week, Follow USDA ChooseMyPlate guidelinesfill half your plate with healthy fruits & vegetables, a quarter with protein & a quarter with whole grains, Take prescribed oral medication, insulin or a combination as directed by your doctor. Please follow the steps below to obtain BC PharmaCare coverage. 2017;167(6):365-374. stream
Initially users will be covered for one year. Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. Dexcom G4 Platinum A9277 Prior authorization is required. 2 0 obj
stream
[CDATA[ 1310 G Street, N.W. Also, many Medicare beneficiaries have secondary insurance that covers their copayment. To add insurance information to your Dexcom online account, take the following steps: The Dexcom G6 Continuous Glucose Monitoring (CGM) System is covered by Medicare for type 1 or type 2 diabetic patients who meet the Medicare coverage criteria. suspension of the applicants driving license, hospitalization or emergency room or EMS visit, glucagon administration, unconsciousness, or seizure. To view a list of compatible smart devices, visit dexcom.com/compatibility. endobj
* The process is simple: Click the link below and fill out the form provided. 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. Sorry, you need to enable JavaScript to visit this website. 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. Pacific Blue Cross will align with BC PharmaCares criteria for Dexcom G6 coverage. Everyones health insurance plan is different. //:2CH!F&Qq& 2021: 65. A Diabetic's Guide: How to Count Carbs Like a Pro. 2021: 69-72. If you are a Dexcom User or Patient, please contact Dexcom Qualified individuals for the ADP funding will receive 100% coverage for their Dexcom G6. Over the next several months the Dexcom G6 online store will be phased out. Currently, CGM system sensors can be used three (3)-90 days before replacement. If rejected, Dexcom will notify the patient of their unsuccessful application and discuss their options moving forward. *You must be 18 or older on a Standard or Basic Option plan to earn this reward. 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. 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. If they do not have a compatible receiver, they will get a new Dexcom G6 receiver. Click here for important updates on coverage and purchase options. CGM users insert a tiny sensor wire just underneath the skin with an applicator. Certain cookies to ensure the proper functionality of our platform ( 6 ):365-374. stream users... Dexcom, Inc. in the early stages is your key to using your medical plan benefits including policy benefits... Basic Option plan to earn this reward coverage with your pharmacist your email are pregnant a new G6... Information including policy, benefits, coding or billing updates, education, and moredelivered directly to questions! 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