Dexcom Delays Medicare Coverage of G6


#41

In my (totally biased opinion - lol) the benefits of the Basal-IQ algorithm on the Tandem t:slim X2 (which require the G6 integrated in order to function) totally trump any other discussions about which cgm is better or preferred for any reason.

As long as the G6 is accurate enough ON YOU to properly drive the Basal-IQ algorithm on the X2, then the combination is a complete game changer.

At this point it seems fairly clear that technical behavior of the G6 can be substantially different enough from person to person that it may work perfectly fine for one person while operating absolutely horribly for a different person.

With the Control-IQ algorithm forecast for launch this Summer of 2019, we (personally) will have to see what the feedback is on Control-IQ. As of right now, I am super happy with Basal-IQ.


#42

Inconvenient, for a T1? I can’t wrap my head around that concept.


#43

What the heck is there to learn??


#44

The insertion process is drastically different.

No big deal for somebody who was on the Seven Plus then upgraded to the G4 then upgraded to the G5 then switched inserters to the push button G6. And then decides to go back to the G5. Trivial. No big deal.

Starting on the G6 push button inserter and then going backwards for the first time to the G5 inserter? Sure. Anything is possible. But not trivial.

The calibration process is drastically different.

First time on the G6 using factory calibrations and never having to perform any calibrations is great. Similar to above, if somebody has years and years experience with calibrations then going from G6 backwards to the G5 is no big deal. But if switching from the G6 to the G5 for the first time now everything about calibrations has to be learned. Same. Anything is possible. But not trivial.


#45

There is nothing drastically difficult about using a g5


#46

I bow out.
:stuck_out_tongue:


#47

My biggest disappointment relating to the G6 delay is that it delays my access to Tandem Basal IQ. I truly believe Basal IQ will help my sleep because of fewer lows and alarms overnight. Will I survive continuing to use G5? Absolutely. At the same time Dexcom is doing a poor job of even shipping our G5 supplies. It is unfortunate that Dexcom’s agreement with Medicare requires monthly rather than quarterly shipments. Late shipments of 7-10 days aren’t a huge deal with quarterly shipments but are impactful for 30-day shipments. Fortunately I use my sensors for 2 weeks and reset my transmitters in Spike and have a needed stash of supplies. Says she whose current order is 2 weeks late. One week is because they didn’t send the monthly reminder email and I’ll accept that blame. The rest is that they put orders into “Processing” and nothing happens. For me the biggest problem is Dexcom isn’t communicating with its customers. They have our email addresses and an honest update or newsletter of some sort would help.


#48

Sounds like Medicare might have the inside track on the diabetes cure timeline…lol.

I’m sure that is very difficult from a patient standpoint as well as a distribution standpoint.


#49

I find this frustratingly sad because to this point, I have gotten my G6, while covered under private insurance, with no problem. I was set up with a Walgreens Community Pharmacy, and a month before my last shipment was used, they would contact me and ship me a new three-month order within five days. I also was told that I could buy the G6 at Costco. I checked with their pharmacy, and they actually pulled a transmitter and a box of sensors off their behind-the-counter shelf to check the prices. I asked about delays when ordering, and the manager told me that they get a shipment every week, so I could have the G6 within a couple of days. These retail places get them with no delays or problems, so why can’t people who are ordering directly from Dexcom? I wonder if I took my prescription for the G6 to a pharmacy like Costco, if I could get Medicare to pay for it through the pharmacy.


#50

Hmm…I’ve never given that a second thought. What I don’t like is when I have to stay home to sign for things such as Medicare Medtronic shipments, or for “controlled” medications. It is such a pain to have to be home, waiting for that knock on the door. That is why I don’t get why some of you here get so wound up about monthly orders that do NOT require signatures.


#51

Yea I want to see how controll iq playes out also, as well as others. There are some pretty good changes comming, if we can be live the hipe. For now I am happy with my work horse the 530g w/enlite, my only complaint is that you can’t turn the backlight on when in alarm, you have to clear active alarm first which is a pain at nigjt, turn my phone on to see screen.


#52

If you are on Medicare, you are not eligible for member prices in the pharmacy at Costco. It’s part of the same ruling that doesn’t allow Medicare beneficiaries to partake in manufacturer patient assistance programs and pump upgrade programs. If you can get a prescription for G6 at Costco and they don’t know that you are on Medicare and you say you’ll be buying out of pocket, you might be able to get your supplies at Costco. Last fall I had a prescription that wasn’t covered by my insurance and I couldn’t get the member discounted price, I do however get the discounted prices for my dog’s prescriptions…


#53

The reason I am frustrated about monthly shipments is that my orders are about 7-10 days late every month. If I only 7-10 days late once a quarter, I would have most of my supplies on a timely basis. After 3 late monthly shipments, I have lost about 25 days. Also it costs Dexcom a lot of money to ship supplies every month versus every quarter.

I don’t have to sign for my pump supplies so that must be a Medtronic thing. If you live near a UPS Store or FedEx Office depending on the shipper, you can probably reroute your supplies to them and pick up your shipment at your convenience. Chances are you can’t do that for controlled medications because the shipper can restrict your ability to reroute your package.

This blogpost is five years old but still accurate. https://testguessandgo.com/2013/11/11/ups-and-fedex-helpful-info/


#54

@Laddie I’m new to the world of Medicare and I’m still in the process of getting my Tandem insulin pump and Dexcom CGM approved. What did you specifically mean about “pump upgrade programs”? Thanks from the one of tudiabetes’ rookies.


#55

So far the Tandem upgrades seem to be OK because they are not charging for them. In the past, for example when Animas had a $99 upgrade cost to move from the Ping to the Vibe with integrated Dexcom G4, Medicare people were forbidden from participating. A lot of people were not told that by their sales reps and were furious. I was lucky not to be on Medicare at that time and had no problem.

My big fear with Tandem is that I suspect they may charge for the Control IQ update and then I wonder if we’ll be able to get it, They are not charging for Basal IQ but of course that is worthless until we get the Dexcom G6.

This inability to participate in manufacturer upgrade and patient assistance programs is part of some anti-fraud SSA/Medicare rules. This is a TuDiabetes screen shot from January that talks about the rules.


#56

Thanks @Laddie for the explanation of what happened in the past and your insight on how it could possibly effect Tandem’s Control IQ upgrade in the future, should they look to charge for it. I appreciate your time and patience helping me understand some of Medicare’s regulations and how they apply to the technologies and potential business models of today.


#57

At least you get FIVE sensors per month, on Medicare. :slight_smile:


#58

That is why my sales rep (and her boss) both told me to hold off on getting the X2 because there is the possibility that if I receive it prior to the roll-out of Control IQ, I may never be allowed to do the upgrade, thanks to contractual issues between Medicare an Tandem. They can’t say for sure, but they said the possibility exists. I do not want to take a chance that I’d be frozen out of Control IQ, my current pump still works, and w/o a G6, I can’t use the X2 as a receiver anyway.


#59

Yes, you’re right, Dave. I manage but there is still stress and anxiety every month while navigating through this inefficient process. I struggle more with pump supplies as I require an every 2-day set change. And then Part B insulin is easy some quarters and a total sh*tstorm other quarters. I always say it is like recreating the wheel every time I order stuff.


#60

I do 2.5 or so on set changes and have had no problem keeping plenty of supplies. We are eligible for shipments every 90 days.

Insulin I get from my doc so we have plenty of that on hand.

Sometimes I feel like my wife and I live in an alternative universe as we don’t have the problems that so many people complain about regarding medical supplies. It is dumbfounding, to say the least.