Dexcom G6 Covered By Medicaid

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Make Knowledge Your Superpower With The New Dexcom G6 Cgm

Dexcom G6 Sensor Insertion

Now with the Dexcom G6 Continuous Glucose Monitoring System, make better diabetes treatment and diabetes management decisions with zero fingersticks and no calibrations.* The Dexcom G6 lets you see your glucose numbers â with just a quick glance at your smart deviceâ and receiver. Get alerted when your glucose levels are heading high or low and share your data with up to 10 followers.â¡ The Dexcom G6 is covered by most insurance plans.

*If your glucose alerts and readings from the G6 do not match symptoms or expectations, use a blood glucose meter to make diabetes treatment decisions.

What Is Normal Blood Sugar By Age

Normal blood glucose levels for adults, without diabetes, is 90 to 110 mg/dL. Learn the symptoms of high and low blood sugar here.Normal blood sugar levels for adolescents.Normal blood sugar levels for adolescentsAge 6-12mg/dLFasting80-180Before meal90-1801-2 hours after eatingUp to 1401 autre ligne

Differences In The Two Systems

Aleppo says that the real-time data from the Dexcom and its alerts of impending problems make it particularly suited to patients whose hypoglycemia unawareness might lead them to manage their fear of hypoglycemia by overeating, taking less insulin, being afraid of exercise, being afraid of driving, and eating unnecessary bedtime snacks to avoid overnight events. Patients sleep better because they know that the alarms can notify them or their companion. For people who have preserved feeling of hypoglycemia, the Freestyle Libre is a great tool convenient and informative. Scanning the flash reader is painless and can be done several times a day. Some patients prefer to be notified about impending hypo- or hyperglycemia, whereas others do not want to hear the alarms.

Ahmann agrees that the Dexcom might be preferred by patients who have hypoglycemic episodes: If you want the most data, you would certainly want the Dexcom platform because it provides more information and has the alarms. The Freestyle Libre is a little simpler for the older patient or others who arent as comfortable with the technology.

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Abbotts Freestyle Libre 2 Cgm Picks Up Medicare Coverage

Abbott announced yesterday that its recently cleared FreeStyle Libre 2 integrated continuous glucose monitoring system is now covered by the Centers for Medicare and Medicaid Services , and available to Medicare beneficiaries with diabetes who meet eligibility criteria.

Indicated for diabetes management in patients aged four years or older, the updated version of Abbotts system can sound the alarm when a users glucose is out of range. Data from a 14-day upper-arm sensor is transmitted to a handheld device, which the wearer can use to view their current readings and recent trends.

Abbott designed the FreeStyle Libre portfolio for performance, access and affordability to make it broadly available to people with diabetes who need it, Jared Watkin, SVP of diabetes care at Abbott, said in a statement. By securing reimbursement, Abbott is making sure our latest life-changing technology can get to everyone who needs it, whether theyre children, adults or seniors eligible for Medicare.

WHATS THE IMPACT?

According to the CDC and CMS, diabetes affects roughly 25% of U.S. adults aged 65 years or older.

While prior devices in the FreeStyle Libre family have already been available to this population, access to the Libre 2s automated alert features could simplify the challenges of glucose management for these older adults.

THE LARGER TREND

Which Cgm Devices Are Covered By Medicare

Dexcom Not Covered By Insurance : Medicaid And Cgm Who S Covered ...

The Dexcom G5 was one of the first of the CGM devices to be FDA approved as a therapeutic CGM in 2017, which qualified the device for Medicare coverage. As with most other technology, diabetes technology continues to evolve, and newer products have since followed suit, including those manufactured by Abbott, Medtronic, and others.

Currently, Aeroflow offers the Dexcom G6, the FreeStyle Libre 14 Day System and the FreeStyle Libre 2, all eligible for Medicare coverage. The Dexcom devices are typically worn on the skin of the torso for up to 10 days, where a water resistant sensor can measure and transmit blood glucose readings every few minutes to a reader or a smartphone app. The FreeStyle Libre is a line of continuous glucose monitors that are typically worn on the skin of the upper arm for up to 14 days. Unlike the Dexcom, the FreeStyle is a flash glucose monitoring system, meaning that while it continually measures blood glucose levels, it only transmits this to a reader when scanned. Each has its own set of unique features, alarms, and recommended age range.

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Dexcom G6 Now Available For Medicare Beneficiaries

Always know your glucose number and where its headed with The Dexcom G6® therapeutic continuous glucose monitoring System! Now, this system is covered under Medicare for people with diabetes on intensive insulin therapy who meet the eligibility criteria.

Ready To Upgrade From The Dexcom G5 To The Dexcom G6?

Get started today with the Dexcom G6 a mobile CGM system including customizable alerts that allow you to make more informed decisions about your diabetes management by providing real-time glucose readings sent right to your smart device! Features of the Dexcom G6 System include:

No calibration required No need to calibrate with a blood glucose meter, eliminating the need for fingersticks.

Long-life sensor Approved for up to 10 days of use.

Sensor insertion with auto-applicator Insert the sensor with the push of a button.

Urgent alerts Receive a 20-minute advance warning of a potential severe hypoglycemic event.

Alert schedules Alerts can be customized for two periods of time within 24 hours .

Slim, water-resistant sensor The new, slim sensor is water-resistant and can be submerged under 8 feet of water for up to 24 hours when installed properly.

No fingersticks The Dexcom G6 eliminates fingersticks for calibration and diabetes treatment decisions.

Use the Dexcom Share feature available in the Dexcom G6 CGM app to provide your real-time glucose data with up to 10 followers.

Gain Control Of Diabetes With The Dexcom G6 System Today!

Medicare Coverage Of Cgm

Medicare has provided coverage for CGM systems since 2017, provided they are classified as therapeutic devices, meaning users can use them to make treatment decisions. These include things like changes to exercise regimen, diet or insulin dosage. While thats still the case, The Centers for Medicare & Medicaid Services have recently relaxed Medicares other coverage criteria somewhat. Previously Medicare coverage of CGM devices was limited to patients who met the following requirements:

  • Have a diagnosis of either type 1 or type 2 diabetes

  • Use a traditional blood glucose meter and test blood sugar levels four or more times a day

  • Are treated with insulin injections or insulin pump

  • Require frequent adjustments to their insulin regimen
  • Have an in-person visit with a doctor to evaluate glycemic control and whether they meet the above criteria, as well as follow up appointments every 6 months after prescription

So whats changed? No longer are insulin injections the only acceptable form of insulin administration for those who are covered. Now, diabetics who are treated with inhaled insulin will be eligible for coverage. Additionally, the requirement for self-testing up to four or more times a day with a fingerstick test has been removed, so diabetics who test less frequently may also be eligible.

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How Does The Dexcom G6 Work

The G6 measures your blood glucose levels without requiring that painful fingerprick. Instead, a water-resistant sensor is inserted below the skin of the torso where it can measure blood glucose levels in your interstitial fluid. The glucose data is then transmitted to a reader or smart device, such as an iPhone or Android, in real-time so you can read the data and share it whenever you choose.

The Dexcom G6 also brings advantages previously not available for the Dexcom G5. These include:

  • Compatibility with a variety of devices.
  • Factory calibration.
  • A one-touch applicator.
  • A low-profile design.
  • A torso sensor that you can wear for up to ten days for consistent blood sugar readings.
  • The ability to wear the sensor while showering or exercising.
  • An acetaminophen-blocking feature designed for those who take acetaminophen frequently and dont want to risk skewing results.
  • An Urgent Low Soon alert feature that can alert you before a hypoglycemia event.

Medicare To Cover Therapeutic Cgm Sets Criteria

Dexcom Review

For Medicare patients on continuous glucose monitoring , the news is good. The Centers for Medicare and Medicaid Services will cover therapeutic continuous glucose monitoring , and have set the criteria that must be met. In the past, it has not been covered.

CMS announced the criteria decision March 23, following their January ruling about granting coverage for CGM. 1

The coverage decision is a game changer for our Medicare patients, says Amy Hess-Fischl, MS, RD, LDN, BC-ADM, CDE. She is program coordinator for the Teen and Adolescent Diabetes Transition Program at the University of Chicagos Kovler Diabetes Center and a member of the editorial board for EndocrineWeb.

The decision is long overdue, says J. Michael Gonzalez-Campoy, MD, PhD, medical director and CEO of the Minnesota Center for Obesity, Metabolism and Endocrinology in Eagan, MN, and a member of the editorial board for EndocrineWeb. The medical literature clearly documents that enhanced monitoring improves outcomes in the treatment of diabetes.

The coverage is effective for service dates Jan. 12, 2017 and later, according to CMS.

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Cms Will Cover Some Cgms Starting With Dexcom G5

The Centers for Medicare and Medicaid Services has deemed certain therapeutic continuous blood glucose meters as durable medical equipment and thus are eligible for coverage.

Its not all cut and dry, of course. Eligible devices must fit several definitions: they must be a class III, FDA-approved device, and they must be CGMs that measure blood glucose levels periodically by using sensors, a receiver and transmitter and eliminate the need for blood glucose strips, informing patients and their doctors in treatment decisions.

Those that are to be used as adjunctive devices, even if approved by the FDA, will still not be covered.

In our view, such devices are not used for making diabetes treatment decisions, such as changing ones diet or insulin dosage based solely on the readings of the CGM, and therefore, have not been covered under Medicare because they are not considered to serve the medical purpose of making diabetes treatment decisions, CMS wrote in their ruling.

CGMs that fall in the benefit category must be used only for the purpose of monitoring glucose levels it must be by prescription, primarily and customarily used to serve a medical purpose and calibrated twice per day with a blood glucose monitor, it must be cleared by the FDA for appropriate use in the home, and must have an expected life of at least three years.

Medicare Now Allows Cgm Use With Smartphone Apps Including Sharing Features

After over a year of continued advocacy, Medicare will cover mobile CGM use and sharing Medicares policy will be updated by June 21, if not earlier

Medicare beneficiaries can now use continuous glucose monitors with approved smartphone apps, such as Dexcoms G5 mobile app! The news represents a major win after 15 months of advocacy to overturn Medicares much-criticized policy not to allow use of CGM with smartphone apps. According to Dexcom, the deadline for the Centers for Medicare and Medicaid Services to update the coverage policy is June 21, if not sooner.

Current G5 users on Medicare do not have to purchase a new receiver or transmitter to use the G5 app to view their CGM data and share it with loved ones they simply need to download the free G5 app and login with their Dexcom account. The G5 app can be found here for Apple devices and here for Android devices. We recommend waiting until June 21 to do so.

Like other users, G5 Medicare beneficiaries can now choose to view real-time glucose data on the G5 app only, the receiver only, or both devices. New Medicare users will still have to purchase a G5 receiver.

Both Medtronics Guardian Connect and Senseonics Eversense CGMs will not be covered by Medicare until they obtain updated FDA labeling .

It is unclear yet whether this coverage decision will extend to using CGM with connected insulin pumps, such as the t:slim X2, which displays G5 CGM data.

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Cgm Coverage If You Have Medicaid

Although its great that most private insurance plans and Medicare now covers CGM for more people living with insulin-dependent diabetes, unfortunately, Medicaid coverage is a bit more sporadic.

Medicaid is the single largest source of health coverage in the United States, providing health insurance to more than 80 million Americans.

Medicaid overage differs greatly from state to state which makes it harder to figure out if youre covered, and unfortunately many states do not cover CGMs in their Medicaid programs.

Anyone living with diabetes under the age of 21 on any Medicaid program qualifies for a CGM, but for anyone older than 21, it becomes a bit more complicated.

20 states currently have fairly comprehensive Medicaid coverage of CGM for people living with any type of diabetes, whereas 22 states only have coverage for people living with type 1 diabetes and 7 states have no published coverage.

Who qualifies also differs from state to state with most states requiring prior authorization from a doctor, but youll have to check with your states Medicaid program for specific eligibility criteria, or reach out to a distributor such as US MED.

No Published Cgm Coverage

Dexcom Not Covered By Insurance : Medicaid And Cgm Who S Covered ...

While there may be loopholes to gain coverage in these states , they do not have published benefit criteria online:

  • Arizona
  • Nebraska
  • New Jersey

Remember that even if a state does not have a published benefit or benefit criteria, all children under 21 on a states Medicaid program are eligible for CGM coverage under the federal EPSDT program.

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Medicares History With Cgm

Up until early 2017, CMS did not cover CGM use because the agency considered it to be precautionary, meaning CGMs were classified as a supplemental type of device not considered medically necessary. CGM also didnt fall under the Durable Medical Equipment category that covers other diabetes devices and supplies at the time, making it technically ineligible for Medicare coverage.

Then in 2017, the agency made a change allowing for certain CGMs to be covered if they were deemed therapeutic or cleared by the Food and Drug Administration as accurate enough for use in treatment and dosing decisions without a requirement for patients to take a fingerstick glucose test for confirmation. That was referred to as a non-adjunctive indication.

A year later in 2018, Medicare began also covering smartphone use with CGMs something its previous policy change didnt address, but it still left Medicare beneficiaries unable to access the latest CGM devices with smartphone connectivity as part of their core function.

As of October 2020, all CGM devices on the market with the exception of those from Medtronic Diabetes are covered by Medicare. These include the Dexcom G6, the Abbott FreeStyle Libre 1 and 2, and the implantable Eversense CGM from Senseonics.

These are all considered therapeutic CGMs that can be used without fingerstick backup tests, except for the Medtronic Minimed CGM, which is why it is not covered.

Three payment categories for CGM are being proposed:

The Need For Continued Advocacy

While advocates and policymakers have come a long way to ensure access to this lifesaving technology, there is still a long way to go until all people with diabetes have the access to the continuous glucose monitoring that they deserve.

All people with diabetes in the 7 states that currently have no published coverage depend on it.

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Medicare Coverage Requirements For Continuous Glucose Monitoring System

Medicare patients with type 1 and type 2 diabetes on intensive insulin therapy may be able to obtain reimbursement if the following Medicare coverage criteria are met:

  • The patient has diabetes
  • The patient is insulin-treated with three or more daily administrations of insulin or a continuous subcutaneous insulin infusion pump
  • The patient’s insulin treatment regimen requires frequent adjustments based on BGM or CGM testing results
  • Within six months prior to ordering the CGM, the patient had an in-person visit with the treating practitioner to evaluate their diabetes control and determine that the above criteria have been met and
  • Every six months following the initial prescription of the CGM, the patient has an in-person visit with the treating practitioner to assess adherence to their CGM regimen and diabetes treatment plan.

In order to qualify for Medicare coverage of your Dexcom G6 supplies, Medicare requires that you have a receiver that is compatible with Dexcom G6 Continuous Glucose Monitor and that you use that receiver with your supplies, even if you also use a compatible smart device. Medicare does not cover Dexcom G6 supplies that are only used with a smartphone or other mobile device.

Medicare covers Dexcom G6 for insulin-requiring patients who meet the Medicare coverage criteria. For the full list of Medicare coverage criteria, visit the Centers for Medicare and Medicaid services website.

Cgm Use And Inhaled Insulin

Dexcom CEO on the companys stock performance and how Covid-19 has changed his business

Along with this recent CGM policy change, Medicare has also expanded coverage for inhaled insulin Afrezza.

Originally, Medicare would not pay for both Afrezza and CGM technology, meaning that someone wanting to use either of these for their diabetes management would have to choose.

The restriction was in the fine print. Medicare documentation previously defined insulin users only as people using either multiple daily injections or using an insulin pump. But this policy change requested by Afrezza-maker MannKind Corp. has now amended the definition to include someone taking an inhaled insulin as an alternative.

This is a win-win for Medicare patients and providers that serve those patients, said Dr. Stella Ilyayeva, an endocrinologist in New York. In 2020, almost two-thirds of T1D Afrezza patients were utilizing a CGM concomitantly. I anticipate this change will open up more doors for the population of Afrezza users.

This rule change also takes effect on July 18, 2021.

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