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We have an update regarding Medicare coverage of the Dexcom G5 Continuous Glucose Monitoring (CGM) System. As you know, Dexcom has been diligently working to confirm a distribution channel to provide Medicare beneficiaries with Dexcom G5 CGM product. We are happy to announce that Dexcom will begin to distribute Dexcom G5 CGM System supplies directly to eligible Medicare beneficiaries within the next few weeks. We have contracted with Ascensia to provide the Contour® Next One blood glucose meter in the bundle of supplies covered by Medicare. Today, we are not licensed to service all 50 states, so we will also be using Medicare distributors to support us.
Here at Dexcom, we have hired and trained a new dedicated Medicare sales support staff to assist you. Priority will be given to existing Dexcom CGM patients followed by new patients in the order they were originally received. As our sales representatives work through the queue, patients can expect to hear from Dexcom or an authorized Dexcom distributor about getting started. This will be a slow process but we will ramp up as quickly as we can.
As a reminder, we wish to reiterate the coverage criteria so that you are aware of what needs to be documented by your physician in your medical records/chart notes to support your eligibility for reimbursement as therapeutic CGM of the Dexcom G5 CGM System prescribed by your physician - The beneficiary has diabetes mellitus; and,
- The beneficiary has been using a home blood glucose monitor (BGM) and performing frequent (four or more times a day) BGM testing; and,
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The beneficiary is insulin-treated with 3 or more daily injections (MDI) of insulin or a continuous subcutaneous insulin infusion (CSII) pump; and,
- The beneficiary's insulin treatment regimen requires frequent adjustments by the beneficiary on the basis of therapeutic CGM testing results.
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Within six (6) months prior to ordering the CGM, the beneficiary has an in-person visit with the treating practitioner to evaluate their diabetes control and determine that the above criteria are met; and,
- Every six (6) months following the initial prescription of the CGM, the beneficiary has an in-person visit with the treating practitioner to assess adherence to their CGM regimen and diabetes treatment plan.
Note: Under the current ruling, the beneficiary may NOT use their smart phone to display glucose data and still be eligible for reimbursement for the purchase of a therapeutic CGM: you cannot use the Dexcom CGM app to display glucose data and be eligible for reimbursement from Medicare. If you do not meet the criteria listed above, Medicare will not cover your supplies and you would need to pay cash. If you are interested in learning about our cash discount, please call 888-738-3646.
Thank you for your continued patience.
Sincerely,
Dexcom
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| | These offers/updates do not apply to Kaiser members. LBL015405 Rev001
BRIEF SAFETY STATEMENT The Dexcom G5 Mobile Continuous Glucose Monitoring (CGM) System ("G5") is a glucose monitoring system indicated for the management of diabetes in persons age 2 years and older. The G5 is designed to replace fingerstick blood glucose testing for diabetes treatment decisions. The G5 also aids in the detection of episodes of hyperglycemia and hypoglycemia. The G5 is intended for single patient use and requires a prescription. CONTRAINDICATIONS Do not rely on the G5 CGM data if you have recently taken acetaminophen. Remove the G5 (sensor, transmitter, and receiver) before Magnetic Resonance Imaging (MRI), Computed Tomography (CT) scan, or high-frequency electrical heat (diathermy) treatment. The G5 is MR Unsafe. Do not bring any portion of the G5 into the MRI
environment. WARNING CGM-based diabetes treatment decisions are only approved with the G5, not previous generations of Dexcom CGM systems. Calibrate at least once every 12 hours using a fingerstick. If your G5 does not display a sensor glucose reading and an arrow, or if you are getting inaccurate or inconsistent readings, take a fingerstick. If your glucose readings and alerts do not match your symptoms or expectations, take a fingerstick to confirm. Failure to do so may lead to hyperglycemia or hypoglycemia. The G5 is not approved for use in pregnant women, persons on dialysis or critically ill persons. If a sensor breaks and no portion of it is visible above the skin, do not attempt to remove it. Seek professional medical help if you have infection or inflammation on or near the
sensor insertion point. Report broken sensors to Dexcom Technical Support. Sensor placement is not approved for sites other than under the skin of the belly (ages 2 years and older) or upper buttocks (ages 2-17 years). To “share” data, you need an internet connection and a separate compatible smart device running the Dexcom Follow App. Contact Dexcom Toll Free at 877-339-2664 or www.dexcom.com for detailed indications for use and safety information. |
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