CMS approves coverage for Dexcom G6 CGM, the only CGM system recognized by Medicare that offers mobile device compatibility and no fingerstick calibration
SAN DIEGO–(BUSINESS WIRE)–Oct. 18, 2018-- DexCom, Inc. (NASDAQ:DXCM), a leader in continuous glucose monitoring (CGM), announced today the new Dexcom G6® CGM System will be covered for Medicare beneficiaries, having met the category requirements for therapeutic CGM systems by the U.S. Centers for Medicare & Medicaid Services (CMS). Coverage for therapeutic CGM includes certain beneficiaries who have either Type 1 or Type 2 diabetes and intensively manage their insulin. The company expects to begin shipping product to Medicare customers in the first part of 2019.
“The Dexcom G6 is a game-changer for people with diabetes, and we are thrilled to provide this innovative technology to the many Americans with diabetes who rely on Medicare,” said Kevin Sayer, President and CEO of Dexcom. “With the CMS policy coverage, Medicare beneficiaries with diabetes who use G6 will no longer require fingersticks to make treatment decisions or calibrate their CGM.”
The new Dexcom G6 boasts a number of features that make it a very powerful diabetes management tool.
Zero fingersticks – No fingersticks needed for calibration or diabetes treatment decisions
One-touch applicator – Redesigned one-touch applicator that is virtually painless
Low-profile wearable – New transmitter with a 28 percent lower profile for comfortable wear
Mobile compatibility – Compatibility with smart device apps to display and share glucose information with up to five people
Alerts and alarms – Customizable alerts and alarms to proactively warn users of pending dangerous high and low blood sugar levels
Who is covered?
According to CMS, therapeutic CGM may be covered by Medicare when all of the following criteria are met:
The beneficiary has diabetes mellitus; and,
The beneficiary has been using a home blood glucose monitor (BGM) and performing frequent (four or more times a day) BGM testing; and,
The beneficiary is insulin-treated with multiple daily injections (MDI) of insulin or a continuous subcutaneous insulin infusion (CSII) pump; and,
The beneficiary’s insulin treatment regimen requires frequent adjustment by the beneficiary on the basis of therapeutic CGM testing results; and,
In six (6) months prior to ordering the CGM, the beneficiary had an in-person visit with the treating practitioner to evaluate their diabetes control and determine that the above criteria are met; and,
Every six (6) months following the initial prescription of the CGM, the beneficiary has an in-person visit with the treating practitioner to assess adherence to their CGM regimen and diabetes treatment plan.
I am covered by a Medicare Advantage plan. When I called a month ago to inquire about coverage of the G5 I was informed that the Medicare Advantage Plans did not cover the G5.
Is there any information available indicating whether the Medicare approval for the G6 includes the Medicare Advantage Plans?
I hope they don’t move us G5 users over to the G6 for several years. There are kinks in the G6 that need to be worked out before I’d want to switch. Hopefully, I won’t be switched for at least another 2 years (IIRC, the receiver warranty for the G5 thru Medicare, is 3 years).
I recently had a sensor failure that I had to call Dexcom about, and while I was talking to their tech support person I asked him - “What is the warranty for the G5 receiver for Medicare recipients?” Sure enough, he said 3 years. I’ve had my old style receiver for 1 year and I’m hoping to hang onto it for a while longer too. The ‘wait time’ for the phone queque is already long enough, it will only get longer once they decide we all should be on the G6.
I have UnitedHealthcare Medicare Advantage and it is covering my G5. I didn’t ask UnitedHealthcare about it, I called Dexcom and they set it all up for me.
I just finished 14 days on my Guardian sensor. I am recharging my transmitter to try for a third week. My Guardians cost $90 each for 7 days. The last time I tried to extend a sensor’s life it started to go flakey after 12 days. This time I have taped everything securely hoping it will help extend its life cycle.
An update re: G6 and Medicare. I just spoke to a Dexcom rep this afternoon. Long story short, it will be near the end of this year before the G6 is available for me.
My endo’s office sent in a request for the G6 last summer, because it was supposed to be available this past fall. I got no response from Dexcom, at all, so I asked when I had my last appointment, last week. They did contact me, and collected the needed documents from my dr., so my order is in the works, but I’ll be going back to the G5 until the G6 is available. I had used the G5 for about a year, but had to give it up when I went on Medicare. Loved the convenience of the iPhone app, and it worked fine. I think my doctor liked it even more than I did, because she had access to better information.
At any rate, I just thought I’d add this information, for anyone here who’s in the same boat I am.
