3 0 obj 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. Dexcom G6 is available at the distributors listed below. After that, it may be renewed for five years. You may have pharmacy coverage for Dexcom through your insurance, which would allow you to get supplies at your local pharmacy. HCPs can prescribe Dexcom G6 to one of the distributors below via the following steps: A patient must call their plan to confirm that the distributor is in their network. and Dexcom CLARITY are registered trademarks of Dexcom, Inc. in the U.S. and may be in other countries. The Dexcom G6 is now available for patients who meet the Medicare coverage criteria. Personal CGM systems can exist as a stand-alone system or integrated with an insulin pump. 1 deadbodyswtor 1 yr. ago Depends on the plan. 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. 3 yr. ago. What if the patients claim is denied at the distributor? Why is Dexcom referring patients to distributors? permission to process your personal information to send you additional Ann Intern Med. 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. <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 16 0 R 17 0 R 23 0 R 24 0 R 25 0 R 31 0 R 32 0 R] /MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> endobj Patients can also self-refer to a DEP registered with the ADP of their choice. When you have diabetes, your body doesnt produce enough insulin or the insulin that is produced is not able to move sugar in your cells, so it remains in the bloodstream. 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. 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. Individual has type 1 diabetes and is receiving short- or rapid-acting insulin therapy; Individual has type 2 diabetes and is receiving short- or rapid- acting insulin therapy; Individual has gestational diabetes or is pregnant and a CGM is recommended by the provider; Updated policy to mirror pharmacy CGM policy, Individual has type 1 diabetes and is receiving short- or rapid-acting insulin therapy, Individual has type 2 diabetes and is receiving short- or rapid- acting insulin therapy, Individual has gestational diabetes or is pregnant and a CGM is recommended by the provider. 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. here. 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. You may opt-out of these communications at any time. As far as I understand it, Dexcom is covered by your pharmacy benefit, not through Anthem. % Contact Dexcom to get the specific information you will need with your insurance plan as plan requirements vary. Yes. Medicare patients currently using Dexcom G5 will be automatically updated to Dexcom G6 when their G5 transmitter is out of warranty. To learn more about public coverage for Dexcom G6 supplies, click here. The patient/family/caregiver agrees to comprehensive and age-appropriate diabetes education by an interdisciplinary diabetes healthcare team and commits to regular follow-up. Dexcom G6 supplies will be delivered at no cost to your patient. Sorry, you need to enable JavaScript to visit this website. With expanded coverage for CGM, the Dexcom G6 Continuous, Glucose Monitoring (CGM) System is accessible for more of your. However, having it gives you a greater chance of developing type 2 diabetes later in life. For more patient-focused information, please visit: Sign up to stay up to date with the latest CGM news, product updates and educational events. This change applies only to the Dexcom G6 CGM. I'm with Anthem Blue Cross in California. Patients can expect their ADP assessment to take approximately 2-3 weeks after the submission of their application form. Please review the terms of use and privacy policies of the new site you will be visiting. Please note you will need to be registered with Fair PharmaCare. ( OVtN Medicare G6 Patient site -www.dexcom.com/medicare. LBL017680 Rev004. All new and existing Pacific Blue Cross members must now apply for BC PharmaCare coverage of the Dexcom G6 CGM. 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. CGM systems consist of a sensor, transmitter and receiver. 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 . * Dexcom data on file (commercial insurance plans for T1 and T2 patients taking insulin). By choosing to request info, you are granting Dexcom, Inc. Once the Special Authority application has been submitted, approval may take 5-8 weeks. The Dexcom G6 devices offers a similar member experience to the FreeStyle Libre 2 system. The Dexcom G6 is covered by BC PharmaCare. The process for Pacific Blue Cross members to obtain coverage of the Dexcom G6 CGM is changing. % stream 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. If CGM devices are a benefit under your plan you can work with your prescriber to obtain coverage through BC PharmaCare. Medicare G6 HCP site -provider.dexcom.com/medicare 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. Error: Please enter a valid email address. The Dexcom G6 costs approximately $3,600 annually and the Libre 2 Flash is approximately $2,600 annually. Medicare covers therapeutic CGM devices under the DME benefit. 2021: 65. To learn more about public coverage for Dexcom G6 supplies, click here. Does Pacific Blue Cross provide CGM coverage? I live outside of BC. 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. You can use these rewards to pay for qualified medical . If approved, your initial BC PharmaCare Special Authority approval period is valid for one year. Continuous Glucose Monitoring (CGM) is a method to track glucose levels throughout the day and night. 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]. Where can patients fill their Dexcom G6 scripts? Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. #1 preferred CGM system Some insurances will cover Dexcom glucose monitoring system based on certain criteria. Personal CGM systems can exist as a stand-alone system or integrated with an insulin pump. If your glucose alerts and readings from the Dexcom CGM do not match symptoms, use a blood glucose meter to make diabetes treatment decisions. 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 If you have prediabetes, there is a chance, with diet and exercise changes, that you can stop your bodys progression to fully diagnosed diabetes. To be eligible for ODSP as a person with disability, patients must meet the program Eligibility criteria. The PDL is a list showing the drugs that can be covered by the plan. Reddit and its partners use cookies and similar technologies to provide you with a better experience. Sign up to receive our monthly email newsletter, tips for healthy living, and important updates. stream 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. 2 Seagrove Partners Q1 2021 HCP Perspectives Survey. Your member ID card is your key to using your medical plan benefits. 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. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. 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). The estimated wait time between referral and an assessment appointment may take from 30 to 60 days. LBL017668 Rev004 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. The process for Pacific Blue Cross members to obtain coverage of the Dexcom G6 CGM is changing. *You must be 18 or older on a Standard or Basic Option plan to earn this reward. How is this posssible. Please note: Information provided with the sample request is validated against Provider's license information. <> Fargo, N.D., 58121. When completing the application, it may be necessary to answer No to the questions in section 2a/2b. Copyright 2023 PBC Health Benefits Society. Pacific Blue Cross will align with BC PharmaCares criteria for Dexcom G6 coverage. These products are covered by U.S. patent. Currently, CGM system sensors can be used three (3)-90 days before replacement. suspension of the applicants driving license, hospitalization or emergency room or EMS visit, glucagon administration, unconsciousness, or seizure. Phone The ACSD website also contains information on How to apply. 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. 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. All rights reserved. Thats why its important to know your risk factors for type 2 diabetes and see your doctor regularly for blood glucose tests. 8 Welsh JB, et al. What patient information is required within chart notes to ensure eligibility along with CMS Medicare coverage 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. Also, many Medicare beneficiaries have secondary insurance that covers their copayment. You should confirm that the request has been approved before bringing the prescription to their local pharmacy. When will existing Medicare patients have access to Dexcom G6? The initial approval duration is two years. A small, reusable transmitter connects to the sensor and sends real-time readings wirelessly to a receiver, so users can view the information. Contact a member Services representative for specific coverage information up to receive our monthly email,... % Contact Dexcom to get the specific information you will be visiting sample request validated! To track glucose levels throughout the day and night its partners use cookies and technologies. Up to receive our monthly email newsletter, tips for healthy living, and important updates validated Provider. The distributor if CGM devices are a benefit under your plan you can work with your plan!, Dexcom is covered by the plan using your medical plan benefits Medicare. Members to obtain coverage of the Dexcom G6 CGM patients must meet the program Eligibility criteria transmitter connects the... Or Basic Option plan to earn this reward a small, reusable transmitter connects to the G6. 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