Medicare DEXCOM CGM coverage

I have been using a Medicare approved DEXCOM CGM for over a year. I have only been able to order a 30 day supply of new sensors. I am trying to determine why I can’t get 3 months of supplies on each order? Does anybody else have this restriction or an explanation of why this is? I keep getting told this is a Medicare restriction, but I don’t understand why? I also use a Tandem insulin pump and Medicare approves a 90 day shipment of these supplies.

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Because Medicare direct only allows Dexcom CGM supply reimbursements for 1 month at a time. Dexcom is in the process of switching all Medicare direct patients to 3rd party pharmacies including mail order options. I have recently been switched to ccs mail order service which also only allows me 30 day supplies as per Medicare requirements. Why you can’t get more than 30 day supply at a time? You would need to have Medicare change their policy. Good Luck with that one!!!

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I was just told a few days ago by a family member who has ordered a Dexcom G6, that he will be receiving a 3 month supply. He is located in South Florida. The rep. told him that it depends on the type of insurance you have. He has Medicare and is a retired firefighter with the county. Seems like Medicare could save a lot of shipping charges by going to a 3 mo. supply. But the gov’t isn’t too smart about stuff like that!!!

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Dexcom just switched me to Edgepark. First order was slow but was able to get 90 day supply of G6 sensors and 1 transmitter.

Are you on Medicare?

Yes, on Medicare for 7 years.

Thank you - I had heard that some non-Medicare patients were able to get a 90 day supply depending on their insurance, but this confirms that some Medicare patients can as well. On my Medicare insurance, Medicare strictly only allows a 30 day supply of sensors.

Thank-you, everyone for your quick replies. I guess it is good to know that I am not the only one that has this problem. I agree it makes perfect sense to ship out 90 day supplies instead of 30 day supplies. The shipping and handling cost saving would be great. I too have recently switched to a third party supplier (Solara Medical Supplies). They informed me it is an insurance requirement, but couldn’t tell me why. I believe it will be better to talk with an informed person at Dexcom, before trying to talk with Medicare.

I’m a Medicare guy who only got 30-day sensor supplies from Dexcom and now that I’ve been switched to Solara also only get 3 G6 sensors from them each month. I also get Tandem t:slim infusion sets and cartridges from Solara and have for several years. Normally, Solara sends me 30 cartridges and infusion sets every 90 days … although, for reasons that I can’t explain, they have sent me 40 infusion sets and cartridges the past two times.

If it matters, my Medicare supplement is through BS of CA (California, not Canada …).

It makes no logical sense to me why pump supplies can be doled out in 90-day increments and CGM sensors can only be supplied in 30-day batches … but one rarely sees Medicare and logical in the same sentence.

Lest I sound as if I’m complaining … or whining … I pay nothing, nada, zilch for insulin, CGM supplies, or pump supplies! I consider myself to be EXCEEDINGLY fortunate and try to never forget that I am luckier than most T1Ds in the US.

Stay safe!

John

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I believe that right now Dexcom is slammed with new business. I’m having trouble getting supplies and I am not on Medicare. Currently I am trying to order. First they told me I had to wait until August 31 to place a new order for supplies, then they told me I must wait until September 3. I can only get one month supplies at a time. Sometimes people are getting less than one month. I think their inventory is very tight. If I don’t get my order quickly I may have to be off Dexcom for a few days.
This may not relate to Medicare’s rules, but it is not just a Medicare thing. Best luck to all of us!

Thanks for your reply. I think you are right about the inventory tightness. There is no doubt that the Covid-19 pandemic is a major factor. I feel your frustration with the ordering process. My third-party supplier won’t allow me to place a new order until 30 days after my previous order. Then they take 10 days on average to fulfill the order. Every month I fear my new supplies won’t arrive before my last sensor expires. If a sensor fails, I’m out of luck if this was my last one. We are told to always have a spare on hand, but this is not possible. That’s why I’m trying to get on a 90-day shipping schedule. Then I would only have to worry about the ordering process quarterly instead of each month. I have become so dependent on my CGM and Insulin Pump, that having to get off these medical tools is very concerning. Take care of yourself.

You could just buy a spare sensor now as a backup so you would not be under extreme pressure to obtain one right away during a failure, or shipping delay, or one of the many other variables that can come along. A pretty cheap option for the peace of mind I would think.

You should call dexcom to replace, with overnight delivery if it last one. If not last, it may ship 3 day.

(Or if you have tandem pump with dexcom, call Tandem, even for sensor. )

Traditional Medicare with Medigap is different than Medicare Advantage Plans. Some Medicare Advantage Plans work more like typical HMOs. Medicare is a whole different ballgame. The Dexcom is considered under traditional Medicare a Medical device like walkers and canes. So now I will be getting my Dexcom shortly and only get 3 ten day sensors for every 30 days. You must re-order when you start the last sensor. No stocking up on sensors. Of course that’s the plan. Why would a T1 want to have an extra sensor or two around when they rely on the CGM readings every day? If the sensor comes off before 10 days I call Dexcom for replacement. Why would T1s hoard CGM sensors, pump supplies and insulin? Because stupid government run plans like Medicare have no clue how miserable it is to run low on supplies.

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Amen!

It’s to keep you on your toes and always checking your calendar. I was able to restart mine once and so I can stay a little ahead of the game. But often I have had to miss a week’s coverage because of late shipments. I am hoping the new distributor will be better. What I hated most about it was having to be on the phone so long every month confirming and reconfirming everything to get the order and then not being sure they really had shipped it. The new company Dexcom hired has an online ordering form with a checklist. Let’s see if I really get my box this week!

I may have gotten lucky on this issue when I started using Dexcom in February. I checked with two or three suppliers and asked about how many months’ worth I could get in an order. It turned out for me that only US Medical could offer a 90-day supply, so I went with them. I’m on Medicare with a supplementary insurance company as well. I believe I’ve done 2 re-orders, with no problems, and reasonable shipping times. (of course it doesn’t hurt that I go one day without a sensor at the end of every 10 days, so as to build up a spare supply over the months).

My understanding is that US Med provides a 90-day supply of Dexcom CGM to Medicare beneficiaries but bills Medicare monthly because that is what Medicare requires. A few other people on Facebook have mentioned getting this same option from other suppliers. But most of us are getting a 30 day supply. If I were starting from scratch with Dexcom Medicare coverage, I would go with US Med to get the 90-day bundle. I have chosen to stay with Solara because they provide me with sufficient pump supplies for an every 2-day change and some suppliers really fight you on that. It seems easiest not to bother trying to switch.

When I was getting supplies directly from Dexcom it was on a 30 day schedule. They switched my supplier to US Med and they sent a 3 month supply. I am on Medicare. Nothing else changed so I don’t think it is a Medicare rule. Didn’t ask to be switched. Dexcom just informed me and did it. So far no problems.

It is interesting as to how US Med handles being able to ship a 90 day supply. Dexcom has a list of around 10 different suppliers who have taken over the shipping from Dexcom. I went with Solara Medical Supplies because they were already doing my insulin pump supplies (90 day shipments). Solara only will do 30 day shipments for Dexcom supplies. I wonder who the other suppliers are that will ship 90 supplies for Dexcom?

With all of the replies I have received on this thread, you would think that maybe Dexcom, the third party shippers and even Medicare could work out a better customer experience. I do love my Dexcom G6.