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Is Dexcom covered by Medicare?

April 5, 2017

Important information regarding the recent Medicare announcement

 

What does this ruling mean? Who is covered?
The ruling means Medicare patients with type 1 and type 2 diabetes on intensive insulin therapy who meet the following criteria may now be able to obtain reimbursement:

  • 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,
  • The beneficiary is insulin-treated with multiple daily injections (MDI) of insulin or a continuous subcutaneous insulin infusion (CSII) pump; and,
  • The beneficiary's insulin treatment regimen requires frequent adjustment by the beneficiary on the basis of therapeutic CGM testing results.

 

Are other CGM products covered as well?
The ruling specifically states that only CGM products labeled as a replacement of fingerstick blood glucose testing for diabetes treatment decisions by the FDA and referred to in the ruling as “therapeutic CGM” will be covered. Thus, Dexcom G5 Mobile is the only therapeutic CGM on the market set to be covered by Medicare at this time.

 

How do I get my Dexcom G5 Mobile?
Both new and existing patients should contact Dexcom by visiting Dexcom.com/medicare, or calling Customer Service at 888-738-3646.

 

Who will send me my Dexcom G5 Mobile?
Depending upon your Medicare plan, you’ll either get your Dexcom G5 Mobile directly from Dexcom, or from one of our authorized distributors.

 

I’m a physician who wants to get my Medicare patients started. What do I need to do?
Existing HCP’s should send all Medicare patients who meet the criteria to Dexcom and we will get them to the appropriate distribution channel.

 

What is the average turn-around time for orders?
Due to document collection, verification and shipping, we anticipate approximately four weeks.

 

How much can I expect to pay for my Dexcom G5 Mobile?
Patients who are covered by Medicare can expect to cover 20% of the costs, while Medicare will cover the remaining 80%.

 

I am using a Dexcom G4 PLATINUM CGM. How will this affect me?
The ruling specifically states that only CGM products approved by the FDA as a replacement of fingerstick blood glucose testing for diabetes treatment decisions would be covered, so the Dexcom G4 PLATINUM will not apply. Currently, only the Dexcom G5 Mobile CGM System meets this criteria and would be eligible for Medicare coverage. Patients using Dexcom G4 PLATINUM may want to talk to their physicians or Dexcom to see if they would be eligible for Dexcom G5 Mobile.

 

I still have questions. Who can I contact?
Please call Dexcom Customer Service at 888-738-3646 for additional information.

 

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