Medicare and Dexcom - Where we're at

Yesterday I published a blogpost consolidating the latest info I have on implementing Medicare coverage of the Dexcom G5. It looks as though Dexcom will be the authorized provider but now they need an agreement with a meter company. Feel free to add any news or comments below.

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Thank-you for writing about this important topic to people of a certain age, @Laddie. I agree with your position that we need to get Medicare supply of the CGM operational before we address the silliness of prohibiting use of a smartphone or receiver. I’ve not read anywhere that Medicare is requiring Dexcom to make use of the smartphone and watch technically impossible for its G5 users.

I’m using the G4 system and it needs a receiver in the data path or the downstream smartphone and Apple Watch will not display any data. I don’t mind the “extra” devices I carry but I know many do.

I want to remind any readers who might see this issue as one restricted to only the age 65+ group. Medicare’s coverage and policies are a large influence on the private insurance market. Medicare coverage of CGMs will cement this policy into many private policies.

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I don’t know how Medicare will deal with policing smartphone usage. However, Dexcom can easily track whether you are using your phone because your transmitter must be registered with the app and Clarity of course knows where it is getting your data from.

In the next couple of months the Tandem X2 will have a software update to allow integration of the Dex G5. That will probably allow me to get by without carrying the receiver, but of course all of that remains to be seen.

I am being more patient than many people but it helps to have a stockpile of supplies.


Thanks Laddie for the update. Much as I would hate to give up my phone, I agree that is a battle for later. It just burns me up that my wife will not be able to keep track of my sugars.

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That’s a nice summary of the issue, Laddie. Thanks for keeping us up to date. Much appreciated.

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Dexcom is now available with Samsung phones. I have a Samsung Note 5, no not the one that catches on fire. It is working lovely and my husband has an Apple phone to monitor me too. It is a free App too.

New here…I have Medicare through Kaiser and two weeks ago was prescribed and received a Dexcom G5 receiver, sensors and transmitters at no cost, no copay. In the “kit” there was the receiver, two transmitters which are supposed to last for three months each and four sensors which are supposed to last for one week each. Kaiser gave me a phone number for the supplier and when getting near the end of the life span of the transmitters and sensors, I am to call them for refills. I’m not there yet but will be in another couple of weeks. At this point I do not know if there will be a copay on replacements.
DExcom recently added Samsung S5 and up, plus LG4 to the list of Apple devices that will allow followers to see your sugars on their phones. My wife is able to follow me now and the app is working very well.

@redhawks2 - that is great you were able to get the Dexcom G5 system under your Medicare.

Which “supplier” did Kaiser provide info to you for? Was it Dexcom directly or one of their distributors?

Kaiser provides Medicare Advantage plans. Advantage plans must cover everything that Medicare covers but they can cover more things as well as set their own rules. Plus they can use their own designated suppliers. So it is very possible that someone on an Advantage plan is already getting Dexcom supplies and not being restricted to using the receiver.

That being said, that doesn’t mean that all Advantage plans are currently covering CGM.

Those of us using basic Medicare along with a supplement plan are bound by Medicare rules and must use designated Medicare suppliers.

There are advantages and disadvantages to going on an Advantage plans versus basic Medicare. For me long term I think I am best off with Basic Medicare but I know in Minnesota there is at least one Cost plan (MN version of Advantage) that has provided CGM coverage for several years.

Hello Tim…not sure about the supplier. It may be Dexcom or a third party that Kaiser uses to handle the replacement items. I will call the supplier tomorrow and find out what the deal is and let you know.

I have a Kaiser Medicare Advantage plan here in the Northwest. I got my new G5 system with 3 boxes of 4 sensors, a 3 month supply. I order new supplies through Kaiser’s DME (Durable Medical Equipment) department, the same as for Pump supplies. The co-pay for the Dexcom system is 20%.

Most of us on Supplemental plans will end up paying nothing because Medicare pays 80% and our supplemental will pay the remaining 20%. But the advantage of an Advantage plan is that you are currently getting your supplies and we are not.

I received this email reply from Dexcom today;

“Dexcom recently partnered with Ascensia Diabetes Care to supply the necessary testing supplies for our Medicare eligible customers. This partnership allows Dexcom to actually begin to send out the full “bundle” that is required by Medicare in order for them to be willing to reimburse. We are still in the process of making sure the field and customer service teams are trained properly to so we can actually start shipping supplies.”

I personally don’t get that warm fuzzy feeling about Dexcom, and how they have handled this whole Medicare Process to deliver their CGMs. They clearly dropped the ball! It’s too bad CMS didn’t allow other medical device companies the opportunity to compete with Dexcom for CGMs. JMHO!

I do not believe it was up to CMS. The ruling which allowed all this to happen was from the FDA. Once the FDA made their ruling, the Dexcom G5 fit within the already established parameters of CMS.

AFAIK - No other company has a CGM with the FDA required approvals for this.

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The phone number is a Kaiser number for Durable Medical Equipment (DME).

Tim, This all about powerful lobbyists in DC. IMO, I don’t believe its because the FDA approved this specfic G5 CGM because of its parameters. If that were true, the FDA approved the Omnipod insulin delivery system, but CMS will NOT consider it DME because the Insulin Delivery Pods only last for 72 hours. However, other tubed type insulin pumps are CMS approved reimbursable even though the pump tubing is also disposed of after 72 hours, but the Omnipod Pods are still not approved? With that said, I believe what ever medical device company can pad the various CMS Provider Reimbursement Review Board members pockets is the company that gets the approval. I truly think Dexcom did an excellent job of convincing for their case. Remember this is all about BIG $$, and HUGE Profits for Dexcom!

Can you explain to me why Dexcom chose to outsource this Medicare operation to Liberty Medical back in March when most Medical Device companies have sales people who take orders, and then the device is sent directly to the patient from the company that manufacture’s it? If Dexcom wasn’t going to make huge profits on this operation then they would have taken on the task to distribute their product from the get-go like they are now going ahead with. Lesson Learned by their CEO who is suppose to be a Accounting/Finance guru. LOL!

Look, my wife average’s two unaware episodes of hypoglycemia/week, and if she could have received an approved CGM I strongly believe that these episodes could have been averted. Had I not been around to help her during these low blood glucose episodes that last well over 30 minutes she would have been in an ICU in a diabetic coma, and then CMS would be paying out more money.

FYI: our order for a G5 was sent to Dexcom by her Endo on 3/27/17, and the formal approval announcement from CMS on the G5 was on 3/24/17, that’s three days later, and to date we are still waiting for an approved CGM device to be sent to us? Do you think someone possibly dropped the ball on this process? So I ask, who do people in need of a approved CGM device ordered by their physician blame? Oh I know… CMS!

Well, I didn’t hear this from Dexcom directly but from another who is following this issue closely. He states that Dexcom told him they are going to be making a Medicare sensor that will be crippled and unable to connect to smart devices. Just the receiver. This is in response to CMS saying they will not reimburse for a Dexcom G5 that is billed to Medicare and used off-receiver. And that Dexcom won’t be able to ask the user to pay for a device used with smart devices. So, Dexcom isn’t being given a lot of choices here.

Big Brother - CMS will be watching you!

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Perhaps down the road, but I have a hard time believing this is anytime soon. I just spoke with Dexcom today. Dexcom feels they are completely ready to start distributing the product directly from Dexcom and are only waiting on the contract with CMS to be finalized/signed.

Clearly any change in the Dexcom product such as crippling (or any functional change) would have to be reapproved by at least the FDA and probably the FCC and CMS as well.

Although CMS has certainly stated very clearly that smartphones are not allowed to be used as receiver, to date there is no hard information that this is going to be enforced.

Also, Ascensia has announced their Contour Next One blood glucose meter will be the glucometer included in the start-up bundle and resupplied for ongoing calibration needs.