Medicare Will Cover Dexcom G5 CGM

Gabby
By GabbyPA Latest Reply 2017-07-17 07:32:08 -0500
Started 2017-04-11 07:05:09 -0500

Exciting news long awaited by so many! Not everyone will qualify, but it's at least a start for those who depend on insulin to keep them alive.

"On March 24, Medicare announced that it will now reimburse “therapeutic continuous glucose monitoring” (CGM) devices for people with type 1 or type 2 diabetes on intensive insulin therapy (“MDI” – multiple daily injections – or a pump). This milestone is a big deal because it establishes reimbursement for Dexcom’s G5 CGM, the only “therapeutic CGM” – meaning it has FDA approval for making diabetes decisions without a confirmatory finger stick – currently available in the US."

Here is the full article: https://diatribe.org/medicare-reimbursement-d...


6 replies

DrJohn
DrJohn 2017-07-16 08:38:28 -0500 Report

I qualify. But, cannot find anyone who will accept Medicare because they pay too little. My secondary insurance who was covering it is now "out of the picture" because Medicare approved it. I don't have hypoglycemic symptoms and almost died several times before CGM. My transmitter expires in a few weeks.

Type1Lou
Type1Lou 2017-07-17 07:32:08 -0500 Report

I've found that dealing with Medicare reminds me of Joseph Heller's novel "Catch 22" or the Monty Python insurance skit where you're covered until you have a claim. While Medicare says it provides coverage, it makes it nearly impossible to obtain that coverage. More and more providers are refusing to accept Medicare due to Medicare reimbursement practices. My insulin provider (Publix Pharmacy) notified me in 2015 that they would no longer cover insulin under Medicare Part B because of those practices. I'm still able to obtain test strips, but every RX is initially denied because I use 8 strips per day (do not use a CGM). I've undertaken to file my own appeals. My former provider (CCS Medical) advised they were not renewing their test strip contract in Florida with Medicare due to reimbursement practices. So frustrating and disheartening!

Luis65
Luis65 2017-04-11 14:44:26 -0500 Report

I doubt I would meet the requirements, but this is good news.

WASHED OUT
WASHED OUT 2017-04-11 15:01:34 -0500 Report

The requirements may still be very strict to where we have to test low on body produced insulin. I think they should open up those requirements to higher numbers that would include more patients without having to have your doctor appeal the coverage denial. Some insurers require a C-peptide test result below .5 nanograms/ml before they will cover the costs of an insulin pump.

WASHED OUT
WASHED OUT 2017-04-11 14:02:26 -0500 Report

If this is so then it is great. People who need this the most can get the life saving help they need.

Gabby
GabbyPA 2017-04-11 14:25:36 -0500 Report

I certainly hope so. It's on reimbursement (not great) but at least they are starting to cover the tools some of us really need.