Hoping they continue moving forward.
This jumped out at me:
Since Medicare has determined CGM devices are durable medical equipment, the program can now cover them on a case-by-case basis. Medicare beneficiaries should work with their health care professional and CGM provider to obtain coverage. [emphasis added]
So, we can apply for Medicare CGM coverage starting now??!
Thatās my read of this language and I hope itās in fact true. In this unsettling time of medical access transition, perhaps a ray of sunshine. I hope my initial understanding holds!
According to a Facebook post by Mike Hoskins at DiabetesMine, the decision applies only to Dexcom G5. I havenāt seen anything about timing, but tomorrow would be great.
. For the sake of so many in need, I hope thatās the case. And I hope the healthcare debate & current actions on the part of the new administration donāt make it a moot point.
This makes sense as it was only the G5 that received the dosing designation by the full FDA recently.
@tiaE, could you please provide a link to that facebook post for your doddering elder??!
Lol @Terry4, one of my grandkids turns 14 tomorrow so Iām not sure youāre as much my elder as you think.
FWIW, I had to ask my daughter how to link so if it doesnāt work, itās her fault.
Thanks, @tiaE! Maybe I played the āseniorā card too soon. Iām old enough to be a grandparent, but am not. For the life of me, I couldnāt find that facebook page!
This applies to G5 only, since that is what has the FDA dosing claim. As of now, MedT hasnāt moved forward on that front.
This also isnāt a national coverage determination, meaning itās a case-by-case determination that CMS and your healthcare provider will consider.
Also, the CMS ruling issued on Jan. 12, 2017 is not retroactive, meaning it only applies to those who get a G5/seek coverage as of that date or afterward.
Definitely a huge step by CMS here! Hopefully, before long, the agency makes a national policy determination on this so thereās blanket coverage access for all on Medicare!
Thanks for this info, Mike. It will interesting to see what the primary determinants will be for Medicare coverage. I wonder if the patient and doctor will need to demonstrate exposure to severe hypoglycemia or a very poor A1c. In any case I expect word to spread about what Medicare favors in granting coverage on a case-by-case basis.
I hope that they are flooded with requests for case-by-case coverage so that they will advance the date of a national policy determination.
Does; this mean the supplies will be classed as DME also (as insulin is, for pump users)? If not, it will be an empty gesture for many of us.
Called the local Dexcom rep this morning, 1/12/17. He was off for MLK day. Hope to hear from him tomorrow to get approval started.
1/24/17 update. No call back yet from New Orleans based rep. Left message again Friday, 1/20. I also called Dexcom support line and left a message 1/20 but no call back either. Went online at Dexcom and Medicare.gov. Dexcom noted FDA approval but said nothing about Medicare. A search of Medicare.gov for CGM and Dexcom turned up exactly zero hits.
I have used Dexcom since late 2008 and been on Medicare and paying for it myself since retiring in late 2012. Would be good to hear from somebody soonš
I read through the FDA document and as I read it, the Dex G5 receiver qualifies the āsystemā to be considered durable medical equipment. The receiver is expected to last three years, according to one analysis. The sensors and transmitters are considered āaccessoriesā necessary to the system. It all should be administered under Part B. At least thatās my understanding at this stage.
My blogpost published yesterday addresses some of the things discussed above. I started with some of the topics that Mike Hoskins discussed in his Diabetes Mine article and then talked more about how the G5 system fits into the DME classification of Part B. My post also has a link to the CMS ruling. It is 15 pages long, but easy to read and very specific on some topics. It discusses things like 60 test strips being covered monthly for the 2-a-day calibrations. We will have the future question as to whether we lose all other test strip coverage, but chances are our doctors will be able to increase the number just as is done now. And if not, Iād rather buy test strips out of pocket than CGM supplies.
Nice summary and analysis, @Laddie. Thinking about the Tandem G5 incorporation of one of their upcoming pumps with the Dexcom G5 system, Iām thinking the absence of the G5 receiver will not eliminate Medicare from covering it. The Tandem pump with the Dex G5 function should easily meet the test of whether it can last three years and qualifying it for the Medicare DME designation.
Iāll be curious to see how Medtronic will proceed in light of this ruling. It appears that they did not anticipate this development.
Will I see you at the Unconference in Las Vegas next month?
Yes, Terry, Iāll be at the Unconference and look forward to see you and Norm and your Loop system.
In my blogpost I didnāt enter into the pump as a receiver issue. Then do sensors become part of that multi component system?
There is a lot to be worked out and no doubt the technology will continue to be in constant flux.
I also wonder how difficult it will be to obtain coverage. I will have used a CGM for over 8.5 years when I go on Medicare in April. How do I prove I need it when it has successfully done the job of keeping paramedics and ER visits at bay?