No Dexcom!

I need help, or perhaps I should say that my Dr. and pharmacist need help trying to get Medicare to pay for Dexcom through Walgreens. Anyone have any advice? Medicare seems to keep raising walls (that’s what pharmacist says) even though I am only trying to change providers - I’ve been on Dexcom through Medicare for over 4 years, practice MDI and sometimes suffer from hypoglycemic unawareness. Previous provider was unreliable but now I’ve gone without CGM for over a week. Any advice as to how those of you who’ve gotten CGM via Medicare from your local pharmacy did so? Seems so silly as starting January 1, Medicare will no longer even be requiring a Certificate of Medical Necessity to get Dexcom Rx. Appreciate any advice as to how I can speed the process - or find a cheap transmitter. Thank you in advance, Bob

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Dexcom is covered under Part B, not pharmacy Part D. Walgreens should be able to put it through Part B, my local pharmacy can do so when needed, but the doctor does need to do the right paperwork and codes.

There is also certain criteria to be eligible for a Dexcom under Medicare. It’s pretty easy, but I think what disqualifies a lot of people is insulin use at least 3 times a day. Dexcom used to help with questions and qualifying, they have farmed out all their supplying now so I’m not sure what they do now.

Per the Dexcom site

"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 (CSII) 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 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."

Is Dexcom covered by Medicare? | Dexcom.

PS Costco for members and then membership in their pharmacy program (free) used to have transmitters for $159 with no insurance.

ADS American Diabetes supply has been a great source for me. They set up mail delivery quickly and just text me every 3 months I respond yes and they send them.

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I also use ADS and they are a fantastic supplier. everything done by text, it was easy to set up as their CS is excellent.

BTW - that is great news about the CMN no longer being a requirement. I had problems with it before as the pharmacy I was using at the time was using the wrong codes. Glad to see the back of that silly form - always made me wonder if Medicare thinks my T1D is just going to suddenly disappear :grinning:

@bob.carlson

I work with the Diabetes Clinic at my hospital. This might be an option to try. My PA there “prescribed” the Dexcom and the Diabetes Clinic did all the paperwork (I’m on Medicare). They are much more knowledgeable about this (well about anything diabetes related!) than my PCP (also at the hospital).

I didn’t have to do anything, and the Dexcom supplies showed up via Advanced Diabetes Supply. They send me a text to when it’s time to reorder, and I confirm it via their website. Couldn’t be easier!

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Do you know if the Walgreens is trying to process as prescription instead of Part B? Maybe you are first to get Dexcom there with Medicare and they are not aware. Dexcom claims all walgreens would do as part B, so check if there is another Walgreens nearby that will process as Part B.

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