To view a list of compatible smart devices, visit dexcom.com/compatibility. Replacement is not covered due to loss, negligence or improper use. *You must be 18 or older on a Standard or Basic Option plan to earn this reward. For a list of DEP clinics registered with the ADP: https://www.ontario.ca/page/insulin-pumps-and-diabetes-supplies#section-3. 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. Where can patients fill their Dexcom G6 scripts? They simply complete a. Please use this form to assist in identifying members who meet Blue Cross Blue Shield of Massachusetts' . Qualified individuals for the ADP funding will receive 100% coverage for their Dexcom G6. Discover how Dexcom G6 can empower your patients to make more informed 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. 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. Sorry, you need to enable JavaScript to visit this website. We use cookies on this website to give you the best experience and measure website usage. 2021: 69-72. Dexcom respects If a member receives coverage through BC PharmaCare, Pacific Blue Cross will coordinate that coverage. Prescribers should follow the new patient prescription process. 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). LBL017668 Rev004 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. Diabetes Technol Ther. *28zVe +2a$ V Glucose results are used by the individual to closely monitor their glucose levels to help them to better self-manage their diabetes. If they do not have a compatible receiver, they will get a new Dexcom G6 receiver. Qualified individuals for the ADP funding will receive 100% coverage for their Dexcom G6. 8 Welsh JB, et al. Insulin, an important hormone made by the pancreas, allows sugar from food to turn into energy for your cells. //]]> Dexcom CARE team - 1-877-339-2664 4 0 obj Personal CGM systems can exist as a stand-alone system or integrated with an insulin pump. If you are a healthcare provider and want to learn more about Dexcom, Seek medical advice and attention when appropriate, including for any medical emergency. * The process is simple: below and fill out the form provided. Diabetes occurs when your body is unable to use sugar in the blood. please fill out the form and a representative will contact you. stream information and promotional communications related to Dexcom products. 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. Medicare G6 Patient site -www.dexcom.com/medicare. https://www.dexcom.com/en-CA/public-coverage, https://www.ontario.ca/page/insulin-pumps-and-diabetes-supplies#section-3, Owing to their developmental stage or a previously diagnosed cognitive or physical impairment, Applicant is, unable to recognize or communicate symptoms of hypoglycemia; or. % riaG1SO[Y!AA~ No changes will be made for coverage of other CGM devices. 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. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 2021;27(6):505-537. 5 Centers for Medicare & Medicaid Services, Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs. Sugar in the blood comes from the foods that we eat. The Dexcom G6 is covered by BC PharmaCare. If approved, your initial BC PharmaCare Special Authority approval period is valid for one year. <>>> A copy of the front and back of your insurance card. Heres everything you need to know about it. To ensure a successful transaction, please confirm your submitted First Name and Last Name match that associated wtih your NPI number. The existing Detailed Written Order (DWO) will be honored. The patient/family/caregiver agrees to comprehensive and age-appropriate diabetes education by an interdisciplinary diabetes healthcare team and commits to regular follow-up. How long will I be covered for the Dexcom G6? The Dexcom G6 costs approximately $3,600 annually and the Libre 2 Flash is approximately $2,600 annually. <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 16 0 R 17 0 R 23 0 R 24 0 R 25 0 R 31 0 R 32 0 R] /MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Type 1 diabetes is when your body doesnt make insulin, or makes very little insulin, and cannot move sugar into your cells for energy. To help ensure uninterrupted coverage for these patients on their private health plan pending ADP determination, provide them with a prescription for Dexcom G6 with the notation "ADP Pending" written on it, in conjunction with their referral to ADP. Send the patients certificate of medical necessity (CMN) and chart notes to the distributor, Let your patient know that they will be contacted by the distributor regarding their Dexcom G6 order, 92% of Dexcom Medicare patients report that they are somewhat to extremely satisfied with product ease of use.4, The Medicare copay for Dexcom G6 is the same price as other CGM brands.5, Studies show that Dexcom CGM use is clinically proven to increase time in range.7-9. At the assessment appointment, a member of the DEP will confirm the patients eligibility and help them complete the rtCGM application form which will need to be sent to Dexcom. LBL017680 Rev004. Your prescriber can complete the Special Authority Request. x\moFna?JpRZ; h@?$-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 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. For a complete description of Medicare coverage criteriavisit theCenters for Medicare and Medicaid services website. ?;E%}p}o]>H7 {"/:|Y }=l~Tx~dEW%[A+ |)Z9D%SE WW@Y\j7+nH! You will no longer need to complete the Pacific Blue Cross prior authorization form. 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. ADP will also notify the patient and prescribing healthcare provider at the DEP to provide the reason for denial. 3 0 obj 2 0 obj 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. Wednesday, Jul 21, 2021 The Dexcom G6 Continuous Glucose Monitoring (CGM) System is now covered through BC PharmaCare under Fair PharmaCare. 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 a current Dexcom G6 patient ages into Medicare eligibility (i.e., turns 65), they will be treated as a new patient. Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically. BC PharmaCare diabetes supplies coverage and eligibility. By rejecting non-essential cookies, Reddit may still use certain cookies to ensure the proper functionality of our platform. First Name* Last Name* Phone* Email Address* How would you prefer to be contacted? 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. 3 dQ&A US Q1 2021 Diabetes Connections Patient Panel Report. Dexcom G6 Mobile CGM (Dexcom) was approved in 2018 and is indicated for the management of . The PharmaCare Special Authority form will be the only one required to obtain coverage from Pacific Blue Cross. However, having it gives you a greater chance of developing type 2 diabetes later in life. ]Odx+q]3hzq- r !sDFFHpe~uF6\h6617ML'i/ii>p@F[0AGqn,LMu{aEJMf? Endocrine Practice. The Dexcom G6 is now available for patients who meet the Medicare coverage criteria. Dexcom Terms of Use and window.__mirage2 = {petok:"1HofDHLtMxUU5p5OUOWGr1uLsA_KL6zgddtQxlS.9Sg-1800-0"}; 2023 Dexcom, Inc. All rights reserved. When completing the application, it may be necessary to answer No to the questions in section 2a/2b. 2 0 obj Blue Cross & Blue Shield of Rhode Island (BCBSRI) follows the medical necessity criteria from the Centers . 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. Pacific Blue Cross members must now apply to PharmaCare for Dexcom G6 CGM coverage. <> Earn Rewards Overview Diabetes Management Incentive Program The Diabetes Management Program by Livongo Coronavirus Update Glucose results are used by the individual to closely monitor their glucose levels to help them to better self-manage their diabetes. % Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. Over time, diabetes can increase your risk for serious health conditions, including heart disease, blindness, kidney failure and even amputations. Also, many Medicare beneficiaries have secondary insurance that covers their copayment. Also, many Medicare beneficiaries have secondary insurance that covers their copayment. Dexcom will submit the completed form to ADP on your patients behalf. Through a variety of programs and resources, were committed to helping you manage diabetes and take an active role in your health. 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