Do you need to see your doctor every 6 months to continue receiving your Dexcom G7 supplies through Medicare? I was under the impression that regulation only applied if you used a pump not if you used insulin pens. Please let me know if this is an incorrect understanding of Medicare.
Here’s the Medicare CGM info you are looking for with the relevant section highlighted.
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A pump with the exception of an Omnipod requires a visit every 3 months, and as @spdif cited above, a CGM is every 6 months.
Why we even have to have a script for a CGM is beyond me. But I suppose it is their way of controlling who they cover.
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It is the every 3 months with a pump that is so outdated. But it will probably never get changed. I could not believe it when I switched to Medicare and went from seeing my Endo once a year to every 3 months. I could not find a way to get an exception.
@ali8 I agree, If you are in good health and have good numbers overall, why every 3 months??? The only reason I see my endo every 6 months because of the requirement of every 6 months on a CGM script. Major blood work is only done once a year on me because it has always been okay. There is such a shortage of doctors and endos it doesn’t make sense. I just don’t see what having a pump or CGM has anything to do with it! Maybe 6 months visits because of catching things earlier, but really, good control in good health and why specifically just having those items makes a requirement… People should be seen by need, some need more visits that aren’t on pumps and some don’t.
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My last endo moved on, just as I switched to MC. Was able get back in with a previous endo, which was great. I think if you talk about D at least some of the time, it counts for MC.
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I used to see my Endo in her office, and she had A1c test gear and would do that, but even before Covid she was more interested in time in range from the CGM than A1c.
During early Covid we did video visits and have continued ever since. She can see a few more patients per hour, and I don’t have to spend driving time.
I upload my Dexcom G6 receiver data to Clarity just before each video appointment. Gives us a chance to review how I’m doing and address any questions. I have chosen not to use a pump (yet), so I need to manage the Dawn Effect, as an example of a topic we might cover. I get value from the interaction and it takes very little of my time. She’s an excellent Endo.
Given that CGM is passive, not like injesting meds, having to have a script to purchase CGM does not make sense. But I suppose the script allows insurance companies and Medicare to limit misuse (at least in their opinion).
I notice that Dexcom is releasing a new CGM device called Stelo. It is for Type 2 diabetics not on insulin and can be purchased without a script. I have read it will cost $80-$90/month. Dexcom’s CEO stated “We wanted to take a group of patients who didn’t want to have to go see their doctor and get a prescription — we wanted them to be able to just order it."