Several news services have reported that Medicare approved insurance for the G7 starting immediately.
Here is a sample news story.
Caution however, just because we can does not mean we should. As many have reported if you are relying on the G7 to operate your pump, be sure that the your pump will work with the pump.
Tandem sent out an email to all their pump userlast week saying:
āTandem has previously communicated that our goal is to launch our integrated offerings within one to two quarters (3-6 months) of Dexcom G7 receiving FDA clearance. We will provide updates on t:slim X2 pump and sensor integration. In the meantime, please continue to use the Dexcom G6 system.ā
It doesnāt say that they will launch within 6 months, it says that they will try to.
If the software were to become avaiable in July, I personally wouldnāt try to switch before 2024. Iāve got too much experience with other products where the demand experienced a sudden surge and exceeded the supply following a launch, and also with bugs in the first release version of software.
Iād rather be a settler than be an early adopter. Pioneers get more arrows-in-the-back unpleasant surprisers than later settlers.
The G7 is a nice refinement, but Iām so far into diminishing returns that its only benefit for me will be convenience - IF itās actual warm up time-to-stable-accuracy is much better than the G6.
I have had enough problems with sensor fluctation during that period causing unnecessary auto-boluses and auto-basal adjustments that worsen control for me that Iām now disabling Control IQ until the G6 is stable. That has taken from 8 to 70 hours.
My profile is good enough that my TIR (in the high 90ās) is only 2% worse without Control IQ than with it. I wish that every pump user could get that degree of control. But no sane person should want to give up all the things that they do that I donāt.
Rick - Thanks for note about Medicare approving the G7. I called my supplier, US Med, and was told that I would be called back to make sure that I am eligible for the G7. They should contact me and be ready for the G7 to ship in early April.
They did warn me that I would not be eligible to receive a Dexcom G7 receiver until June 2024, the five-year anniversary of the G6 receiver that Medicare paid for in 2019.
Iām getting conflicting info from US Med. I called yesterday to inquire (I currently get the G6 from them) and was told Medicare is not yet covering the G7 and they āput me on a listā and will contact me when Medicare covers it. On Dexcoms site they state Medicare is now covering the G7. So has anyone actually got the G7 from US Med (or anyone else) thatās on Medicare?
@Baddog40 - When I talked on the phone with US Med, I also heard them say that they would put me on a waitlist to begin the process when Medicare covers the G7. I asked them whether this was a US Med eligibility policy or if indeed theyāre saying that Medicare does not cover the G7 yet. They conceded that this waitlist eligibility was an internal company process to deal with initiation of their Medicare customers lining up to receive the G7.
I think theyāre (maybe unwittingly) leading you to believe that Medicare is responsible for this relatively short delay in the process is incorrect. I suspect that they thought the Medicare go-ahead would take longer and were not prepared (as in getting G7 stock on the shelves) to initiate G7 shipments.
US Med has been so good in their policies and service, Iām more than willing to cut them some slack. I have the luxury, however, of existing supplies of G6 sensors that I plan to use while I build up my ācomfort bumpā of G7 stock so that Iām never faced with a ājust in timeā sensor crisis.
This sounds like it could be a problem. Since Medicare will only pay for a cgm when a receiver is purchased with it (under current laws), it is possible that they could refuse to pay for G7 until you have a receiver for it, which in your case is June 2024. Did your Medicare supplier state otherwise?
Yes, US Med said that the use of the phone app was good enough. Yes, itās credible that Medicare could refuse payment for G7 sensors not supported by a G7 receiver. Iāll see what transpires.
Interesting as I had to pay the full amount for the receiver to be covered. This is through a Medicare Advantage plan offered by my former employer, Verizon. I had to pay $450 USD for the receiver but have not been charged anything more in the 2 years since - not for sensors or transmitters. I think thatās covered the $450 at $18.70 per month.
I do wonder if the Tandem pump counts as a receiver with G7 when thatās available.
All CGM systems require a prescription in order to buy them. Dexcom G6ās average cost without insurance is about $450 for the receiver , $300 for 1 transmitter, and $420 for 3 sensors (enough for 30 days). Dexcom vs. FreeStyle Libre: How Do These CGMs Compare? - GoodRx
Yes, the Tandem pump now qualifies as a receiver under Medicare. āCoverage of a CGM system supply allowance (code A4238 or A4239) is available for CGM systems when the beneficiary uses a stand-alone receiver or insulin infusion pump classified as DME to display glucose data.ā Article - Glucose Monitor - Policy Article (A52464)
This is an astonishing price difference given that for $299 / month CDN you can get a years supply 36 or 37 G6 sensors (with a few more for the inevitable fall-off, or sensor failure, or remove for MRI or what have you) AND 4 transmitters, delivered to your door! And $299 CDN is about $210 US.
Every time I hear about US costs for healthcare, I imagine you all must be getting fantastic high quality care.
I use my receiver every day and I would use a new one as well. My office has two doors and right now with only one receiver I cannot keep both doors open at the same time.
The issue is the release of Medicare stock by Dexcom. You know, the extra fancy packaging that says itās for Medicare. Probably easier for Dex to fill the regular orders first.
The issue is that we expect everything to happen in real-time as soon as it is announced and so do Medicare and Dexcom. The difference is that Real-time to a diabetic is for good things to happen within the next few days while real-time at Medicare and Dexcom is for good things to happen within the next few calendar quarters.