Dexcom Delays Medicare Coverage of G6


#61

When I was at the Type One TCOYD retreat last August in San Diego, I talked with Tandem representatives at their show table. The subject of the Control-IQ software arose. It was then that I learned that Tandem had licensed the TypeZero algorithm written by University of Virginia affiliated staff.

One rep told me that he thought since Tandem paid a significant licensing fee, there may very well be a fee charged to upgrade to Control-IQ. And that would set up an insurmountable hurdle for Medicare beneficiaries to economically secure this tech upgrade.

I know that Medicare officials need to guard against fraud, that’s an important function of their job. But why is it that beneficiaries are suffering the negative consequences of the agency’s lapse in fraud enforcement in the past?

In Laddie’s example above, if memory serves me, Medicare beneficiaries couldn’t even take the $99 out of their own pockets for the Ping to Vibe upgrade. I can’t see the rationale.


#62

Terry: right. The rep (IIRC) told me there is no way to pay for the upgrade OOP if using Medicare.


#63

It will be Tandem’s choice whether to charge the existing X2 consumer an upgrade fee. There certainly is a cost associated with the licensing from TypeZero (now acquired by Dexcom) although whether that cost is significant or not is likely in the eye of the beholder. Tandem certainly has the legal option to eat the cost as a goodwill gesture for its existing user base while adding the cost to the pumps going out the door when Control-IQ becomes an update as delivered from the factory.

IMHO this small financial impact would be more than offset by consumer goodwill.

Look at how much word-of-mouth the Tandem pump currently gets with the vast majority of it excellent.

Compare that to the word-of-mouth that Dexcom has been receiving of recent.

One really can put a price tag on that sort of thing.

Time will tell.

Control-IQ is forecast for launch this Summer. It was surprising that no public decision as to existing consumer upgrade cost was announced during the recent FY2018 earnings call. It would be even more surprising for no such announcement during the 2019 Q1 earnings call which last year was held on April 26.

One could only hope the new CEO would not be looking to start out on a negative note.


#64

I’m so tired of it all. Jumping through all these hoops, the stupid update with horrible beeps that are insane and no customer service.
Terribly disappointing!


#65

@SherryAnn
If you are financially able you may consider getting a one month supply of the sensors and then appealing to Medicare for reimbursement. The risk is, it may not work, and you may end up not being reimbursed for what you bought. That’s why you have to decide if you can take that risk. If you appeal the coverage I would ask your provider to write a letter stating why the sensor is medically necessary and that you are currently on the G6 and have been prior to being eligible for Medicare.
It may work.

The one thing with Medicare is that they don’t do “prior authorizations” for matters like this. You have to argue it AFTER you have already paid for it.


#66

What beeps and update are you speaking of?


#67

I am on Medicare and have my G5 integrated with my Tandem pump.
I just cannot wait till I can get the G6 so I can use Basal IQ on my pump!
I have been waiting for the G6 for several months and the news of the rollout delay is terribly disappointing!


#68

Totally understood.

The Basal-IQ is FDA approved to work with both the G5 as well as the iCGM (ie - G6). It would have been nice if Tandem had made the business decision to support both the G5 and the G6 with the Basal-IQ algorithm.


#69

The Dexcom Cgm No volume control. Beeps so loud I won’t wear it


#70

LOL! that bad, for you, eh?


#71

There are many people very unhappy with this.

I take it you do not have one from Déxcom?


#72

I think it would be ideal if there was a volume control, because I would like it to be louder.


#73

I spoke with Dexcom. The expected date is the fourth quarter of 2019 - but the G6 has been approved by Medicare, and has been since October - despite every Dexcom rep in various divisions being adamant that Medicare had not yet approved the G6!!! The Dexcom response is that they don’t have availability - but when I interrogated him further and pointed out that if they knew that the April date was pending, why didn’t they increase production output? His answer: “I apologize, sir.” When I then told him what I previously determined - that Dexcom decided to extend the time period where they’d obtain higher sales income (Medicare doesn’t pay that well) and reap the profit from its recently-launched G6 television ad, his response: “I apologize, sir.” You get the idea. Even worse, I now believe that Medicare had approved this earlier (it was originally October 2018), but Dexcom’s greed extended from October to December to April and now to…who knows?

While a class action lawsuit might wake them up, we can at least recognize Dexcom for what it is: a profit-first company that acts like it’s selling smartphones and place those with low-paying insurance last - and lies their backside off.


#74

PS. I just confirmed from a Dexcom supervisor that Medicare DID approve the G6 in October!!!


#75

I thought they were a charity. I must of been wrong.


#76

A class action suit to do what exactly? Are you going to get a lawyer to force Dexcom to increase their output? I can’t believe some of the nonsense I have been reading lately about Dexcom and what people think they are going to do about it.


#77

You’re just so clever, Jim. Your insight is blinding.

Try these:

  • they have intentionally been dishonest since October 2018, telling us that Medicare had not approved the G6

  • they’re did the ssme when December 2018 arrive

  • they’ve now done it once again, not only still lying to us as well as not informing their 1st tier phone reps in different divisions, the latter still believing that Medicare has not yet approved the G6 but will do so in April

  • Medicare employees promulgated the same falsities, thereby being in (uh oh) collusion with both Dexcom and sellers - because in order to sell the G6, medical suppliers had to sign a three-way contract (Dexcom, Medicare and themselves) which blocked automatic crossover and prohibited direct billing to Medicare Advantage, MediGap and Medicaid insurance

FYI, profit-first is not the same as for-profit. For-profit is ethical in the manner in which it generates profit; profit-first is not, prioritizing maximal profits by not servicing those who have so-called low pay insurance - and lying to them as well.

It’s one thing to be unable to purchase a top-level Telsa. It’s quite another when a DME company stretches the waiting period for being able to acquire equipment that can enhance and extend life. The latter should never be the modus operandi for any health- or medical-focused organization.

Perhaps you think that this is ethical, aboveboard, normal behavior for a for-profit durable medical equipment company. Perhaps you therefore thought a joke was in order.

I and many others do not.


#78

G6 is a good product, but in the scheme of things it really not that much better than G5. The first 12 hours are definitely more accurate, but overall you’re not missing out on much.


#79

My situation is similar, except that I was using Medtronic Enlight CGM. World of difference, I love the G6, at end of my 1st 3-month supply, but now on Medicare. Feel I’ve been lied to by Dexcom, I got the G6 because they said last year it was approved by Medicare (and it was!), but then said wouldn’t supply it until april 2019, now they are saying Q4!
Will NEVER go back to Enlight, was so bad.
I also don’t want to “go backwards”, but feel I would be better off going to G5 than Enlight again, but I terribly resent what dexcom is doing, and will tell them that in no uncertain terms when I now have to try to get a G5 system from them asap under Medicare.


#80

Many people love the g5 including me and my wife. It is so much better than enlite. for me it is more comfortable, it doesn’t make me itch like the enlites did, it doesn’t fall off when I get sweaty, it’s more accurate. On Medicare with gap insurance the g5 is free. When I was on enlite I had group insurance so I had to pay 20%. It’s not like you’re getting a garbage system if you get the g5.