2021;27(6):505-537. NOTE:In addition to the above criteria, product specific dosage and/or frequency limits may apply in accordance with the U.S. Food and Drug Administration (FDA)-approved product prescribing information, national compendia, Centers for Medicare and Medicaid Services (CMS) and other peer reviewed resources or evidence-based guidelines. window.__mirage2 = {petok:"1HofDHLtMxUU5p5OUOWGr1uLsA_KL6zgddtQxlS.9Sg-1800-0"}; Pacific Blue Cross will align with BC PharmaCares criteria for Dexcom G6 coverage. 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. Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically. Heres everything you need to know about it. Through a variety of programs and resources, were committed to helping you manage diabetes and take an active role in your health. <>/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>> aIJ'%d>8odMw|; dK^OpX`BHb ' iAGn u)ci` pi{QIZ`e[8q]smU9*2=C%8CJpx Also, many Medicare beneficiaries have secondary insurance that covers their copayment. The patient/family/caregiver agrees to comprehensive and age-appropriate diabetes education by an interdisciplinary diabetes healthcare team and commits to regular follow-up. <> 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. You should confirm that the request has been approved before bringing the prescription to their local pharmacy. Click here to download a printable PDF copy of the ADP Application for Funding Real-Time Continuous Glucose Monitoring System (rtCGM). 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. 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. Coverage Information | Blue Cross and Blue Shield of Texas Find Care Shop Plans Prescription Drugs Insurance Basics Member Services Ask Question Request Brochure Request Agent Call Us Please send us your question so a licensed agent can contact you. 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. Receiver is required to be used along with smart device in order to receive Medicare benefits for CGM. Wednesday, Jul 21, 2021 The Dexcom G6 Continuous Glucose Monitoring (CGM) System is now covered through BC PharmaCare under Fair PharmaCare. Are you a current customer facing financial constraints? Pacific Blue Cross members should first check to see if CGMs are a benefit under their plan. CGM systems consist of a sensor, transmitter and receiver. Unlike a blood glucose meter (BGM), which provides just a single glucose reading, CGM systems can provide real-time, dynamic glucose information up to every five minutes. At this time, it is anticipated that private insurers already covering Dexcom G6 will expect plan members with type 1 diabetes to be assessed for ADP funding. diabetes management decisions to help them stay in target glucose range. This means they will automatically get a new Dexcom G6 transmitter and sensors with instructions on how to update the receiver and app. Sign up to receive our monthly email newsletter, tips for healthy living, and important updates. //H7 {"/:|Y }=l~Tx~dEW%[A+ |)Z9D%SE WW@Y\j7+nH! We comply with applicable . To learn more about public coverage for Dexcom G6 supplies, click here. 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. Qualified individuals for the ADP funding will receive 100% coverage for their Dexcom G6. Diabetes occurs when your body is unable to use sugar in the blood. Click here to download a PDF summary of the Ontario ADP coverage information. For these members, CGMs will only be covered under their pharmacy benefit. Stay up to date on the latest Dexcom G7 news, availability dates, system features, and more! //]]> This process . 6 Grunberger G, et al. Requires multiple daily injections of insulin or insulin pump therapy as part of intensive insulin therapy. 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. 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. 0!o!eg[Z'K'xt[ Anyone with PharmaCare Special Authority must get their Dexcom G6 supplies from a pharmacy. The Dexcom G6 is covered by BC PharmaCare. Pacific Blue Cross supports this change, which will provide British Columbians living with diabetes more options for diabetes management. If a current Dexcom G6 patient ages into Medicare eligibility (i.e., turns 65), they will be treated as a new patient. and Dexcom CLARITY are registered trademarks of Dexcom, Inc. in the U.S. and may be in other countries. 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. If a member receives coverage through BC PharmaCare, Pacific Blue Cross will coordinate that coverage. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. *You must be 18 or older on a Standard or Basic Option plan to earn this reward. 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. A customer representative will follow up with you to process a full insurance benefits check after reviewing your information. Seek medical advice and attention when appropriate, including for any medical emergency. permission to process your personal information to send you additional 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. 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. 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