I’m on a pump and Dexcom g6. I am trying to get my first sensors/transmitters through Medicare. I am a CDE and am fully aware of the process and documentation needed. I started this process at my last drs visit on 8/14 and still do not have sensors. Edgepark was my distributor and they were fine until Medicare, Dexcom rep hooked me up with Pinnacle. They said they faxed my Dr. office. Office said no they didn’t. So I had it sent to my local Walgreens where it has been for a week. I already paid cash for a box of sensors on line because I was running out. Experience with average wait time for a first fill at Walgreens? Pharmacist in store can’t help because it’s handed through Walgreens Medicare department.
@Bobbie2 if you are paying cash and are a Costco member, the turn around time is 2 days (plus they have very good cash prices with their CMPP)
Once I went on Medicare years ago, getting my diabetic supplies became a very time-consuming and frustrating process. I’ve been using Dexcom CGM for many years and tried to get them through our local Walgreens but they were either unwilling or unable to do the necessary paperwork to supply me with the sensors. The good news is Medicare started covering them at my current mail-order vendor (Better Living Now) and now they ship them to me much quicker and without the numerous contacts and phone calls it used to require when they were paid for by my private insurance.
I work with Byram. The are good & play nice with Medicare. If office sends to Byram, get copy of everything sent. If Byram contacts & says “lost…”, you can say, I will send it.
Has happened to me several times since 2017. This is my solution working with Byram.
Addition: Insulin is a DME expendable under Medicare Part B & with my secondary, insulin cost = ZERO.
Without complicating your choices, most Dexcom G6 suppliers are only allowed to ship 30-day “bundles” so you have to do the Medicare shuffle every month. Some suppliers … US Med is one, I don’t know the rest … are allowed to ship you 9 sensors and a transmitter at a time under Medicare.
Why is that true for only some of the suppliers? I have no clue …
And, as @Jay6 says, under Medicare your insulin is DME and can be free … and as a CDE you probably know the magic words that need to be on your prescription. Two caveats: most commercial pharmacies take multiple tries to properly process your first prescription because they so rarely encounter a Part B prescription. And, this will burn you if you travel a lot: a Part B prescription is not transferable even to a different pharmacy in the same chain. Why? No clue …
Stay safe!
John
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No problem with my insulin going through part b at Walgreens. It was free. Pharmacist to tally understood the Dexcom process and told me it would take awhile. Just don’t know what awhile means My doctors office recently laid off two employees. I was one of them and myself anD the other person who got laid off used to take care of all this paperwork stuff. Now they don’t answer the phone or emails so they may be part of the problem. Please share Any positive experiences with distributors in case the Walgreens thing doesn’t work. I’m giving them another week. Two weeks seems reasonable to me.
Welcome to the community, @Bobbie2. Interesting that you can view the supply chain challenge we all face with securing our D-supplies from both the patient and professional provider perspectives. Medicare can complicate the process since they absolutely require suppliers to cross the t’s and dot the i’s or they won’t pay them.
I switched to US Med earlier this year for my Dexcom G6 Medicare supplies. They ship a 90-day supply (9 sensors, 1 transmitter) with a minimum of fuss. I’ve now received two such shipments with my only role was replying to a single text message. I hated doing that frustrating supply dance every 30 days!
The best solution to this whole problem is putting away a safety excess of supplies to buffer against the inevitable supply hiccups. Good luck with finding your solution.
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I saw some people found a walgreen that was experienced with medicare billing, and would either directly ship to you or your local walgreens. Maybe ask your local Walgreen for suggestions (other locations) for faster processing.
I’m right there with you. I just went on Medicare too and have been trying to get dexcom supplies too. It is very frustrating. I don’t understand the difference. My pump supplies came without a problem from Edgepark filed with Medicare.
I called Dexcom to tell them I was going on Medicare, I had not been getting them through Dexcom, I had a local pharmacy that used to send them that couldn’t do Medicare. Dexcom said they didn’t ship anymore and would hook me up with ADS, and be warned it could take a little time and if I needed emergency supplies they could supply it. I got sent paperwork from ADS through e-mail within a few days. I had a 90 day supply and a transmitter in my hands in about 2 weeks total. This was last June.
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Thanks! Hearing which distributors will give 90 days and provide a good experience is very helpful.
Thank you. Good to know. A 90 day supply would be great. No fuss even better
My understanding is that the supply companies that provide 90-days of sensors plus a transmitter are billing Medicare only 30 days worth at a time, per Medicare rules. Most supply companies don’t do that. Options for padding the time before receiving new supplies are also getting a few replacements for defective sensors that hadn’t lasted the required 10 days or restarting them yourself. Another way to accumulate extras is at the beginning when you can delay starting the use of the g6s for a month. That will give you a 3-sensor pad.
Large pharmacies such as Walgreens or WalMart and others had always resisted billing Medicare under Plan B either through ignorance of the procedure or because they get paid less than when they bill through Plan D or health insurance. They are also supposed to bill Medicare under Plan B for test strips if you don’t use g6s. But they seldom do that either.
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This morning, I received the US Med prompt to initiate my next 90-day order. It came as an email, not a text. This email prompt arrived 78 days after my last US Med sensor/transmitter shipment. I’m so impressed with the timeliness and simplicity of their operations. I responded to the email and confirmed my shipping address – just a few clicks! This means they will have plenty of time to ship me my next Dexcom shipment on time with no more action required on my part.
@Marie20, it’s great to see other companies do this as well. Thanks for posting your good experience with Advanced Diabetes Supply. It’s ironic that simple business execution and timeliness make companies like US Med and Advanced Diabetes Supply stand out in a sector that continues to be mired in burdensome patient efforts to keep their shelves stocked with essential medical supplies.
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I love US Med. I don’t even think about getting my supplies, because US Med makes it so easy. Every 90 days I get an email and then a box of supplies.
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I just think it’s rather amazing the variation in the experiences we have had often with the same vendors. I used to buy from Byram but it was so frustrating that eventually my insurance company told me to try another vendor. I had bought supplies from them for several years and my insurance company had always paid them fully according to their contract and then out of the blue Byram tells me I have no insurance coverage. The order clerks could look at the orders and see they had been paid in full but when it came time to ship them the insurance people would stop the order. So I finally had to go to another vendor to get the supplies I needed.
I too used to get my insulin at no cost from Walmart but they claim that Medicare had change the billing and would no longer cover it fully and they wanted some enormous co-pay. So I’m puzzled as to why some people can still get it covered fully. At present I get it through the local drugstore under my drug plan and have $100 co-pay every three months.
And it also puzzles me that some people are using Walgreens to get there Dexcom supplies with no problem and my local one said they can’t do it because of my insurance which is Medicare as my primary insurance. And I do get my Dexcom supplies from Better Living Now and they are fully covered by Medicare.
When I was shopping for another vendor I called Edgepark and was told they do not take Medicare and yet I see someone else saying they are getting supplies from them with no problem. Of course this was a few years ago so maybe things have changed.
It’s just rather amazing and frustrating the variation that we have trying to get our diabetic supplies but it is great we have this resource to compare notes and promote those that seem to be doing a more efficient job.
Are you on a pump? If you are you should NOT be paying for insulin if you have regular Medicare and a supplement. I’m not sure about Medicare advantage plans since there is no part B. It probably then goes through the drug plan. Maybe someone else can help with that. If you are on injections insulin goes through drug plan and you will have a copay. Not all pharmacies can bill Medicare Part B and/or your Medicare supplement but most large chains can. cvS Walgreens Rite aid etc. but you may have to persist until you get a pharmacist who knows what you are talking about.
For Dexcom, Walgreens has turned out to be a bust so far. They have had the prescription for almost two weeks and the Medicare department has done nothing with it. Haven’t contacted my doctor for chart notes even. So I’m going to pull the prescription and start over. Edgepark wasn’t a problem until I went on Medicare then the service went down hill. I’m going to try pinnacle Medical Solutions next. They’re were recommended by the Dexcom in house person who was my contact for problems when I was working as an educator. You’re right the difference in experiences we all have is mind boggling
I just received another 90-day Medicare shipment of 9 Dexcom G6 sensors and 1 G6 transmitter from US Med. I received this shipment on October 19, 2020 and the previous 90-day supply on July 20, 2020. That’s darn close to 90 days.
I remain impressed with this performance, especially since I only had to respond to one email inquiry from US Med. No waiting on hold, no interminable phone tree and no circular finger-pointing typically experienced with missed supply shipments.
There are other companies who also do this well. I’m happy I’ve connected with one of them.
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Based on your recommendation. I’m about to go with US Med.
Another company that seems to do 90-day G6 supplies is Advanced Diabetes Supply (which is actually North Coast Med in San Diego).
Certainly the companies that have figured out how to bill Medicare every 30 days but ship a 90 day supply have asked themselves “what would be best for the customer?”
Thanks for the tip.
John
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