This was a new one for me that I found interesting. Medicare refused to pay for test strips because the person had a DexCom CGMS.
I have seen a hint of this problem to come a couple of times in the last year but this is the first flat out refusal I’ve seen with the reason for denying them being “has DexCom sensor.”
So DexCom G6 has been indicated to be use without having to “calibrate.” (Personally, I’m pretty sure that is why Medicare approved DexCom but refuses to approve Medtronic. They don’t want to pay for a sensor and strips.)
My personal theory on the matter is this:
DexCom was supposed to release the G6 to Medicare patients in March but it has been delayed. My guess is that Medicare has been gearing up to deny test strips to CGMS users in anticipation of them receiving the G6 (who knows that may be giving Medicare too much credit and Medicare may think that ALL DexCom CGMS are indicated for use without calibration").
(Why Medicare would assume that just because the G6 would become available in March would mean that automatically every single one of their patients would be on the G6, I’m not sure.)
I wrote a letter to our jurisdiction medical director for Medicare DME and pointed out that the G6 has been delayed and that the G5 still, technically, requires calibration for use so test strips are still a necessity. I sent that yesterday and I’m still waiting to hear.
I’m curious if anyone else has run into this yet?
Slightly off topic but another interesting thought:
For Medicare to continue cover pump supplies, a person has to be testing their blood sugars four times a day. So what is Medicare going to do when they (Medicare) won’t cover test strips because a patient is using a sensor and doesn’t “need” test strips but they (Medicare) still require four times a day testing to use the insulin pump.
In a perfect word, Medicare would realize that with the CGMS that doesn’t need calibration there should be no reason why a person has to physically check their blood sugars four times a day as an insulin pump use requirement but, knowing Medicare, somebody is going miss that memo…