Tandem Pump-Medicare-Dexcom G5


#1

Tandem users that are on Medicare, you will not be able to use your pump with the Dexcom G5 CGM. I was just approved to get a CGM from Medicare and I’m already have a Tandem pump, as I was getting ready to use the G5 I called Dexcom for help and was told by Dexcom I would not be able to use my pump or any mobile device. Medicare will consider only their receiver as it is a durable medical equipment, not your pump or mobile device because they are not durable medical equipment. They told me that they are working with Medicare to change this but that could be years from now…who knows???
What a let down! Why was I not told all of this before I got my CGM and approved by Medicare I may have decided not to get it.


#2

@Daisy6, I am not on Medicare, but if it were me I would use the pump with a G5. The reason being that Dexcom only knows if you use it that way if you upload to the Dexcom servers in which case they would have to report you to Medicare or lose their funding from Medicare. Since when you upload your pump it goes to Tandem servers theoretically Dexcom doesn’t know and they’re able to turn a blind eye. Alternatively you could use other upload Dexcom has absolutely no access to. JM2C


#3

im not a tandem user but i was told that you can use the CGM with the pump but you cant use the mobile app of the CGM. Medicare doesnt cover for that part. And dexcom i believe is incorrect. i was told you can use the pump with the CGM. again the CGM mobile app is not covered via medicare. again this is what ive been told.


#4

Tandem offered the Dexcom download not to long ago because they where working with Dexcoms G5, but it fall through. I was told if you use your pump instead of the Dexcom receiver and if Medicare finds out they will charge you for the unit because you did not follow their guidelines. My pump a Tandem2 is not part of the Medicares durable medical equipment so they won’t cover it. “This is just for the people that are on Medicare.”


#5

@Daisy6
Bottom line is you have to do what you think is in your best interest. I am in agreement with @El_Ver however.

I do not believe that the Medicare decision restricts you from using the Dexcom G5 integrated with the Tandem t:slim X2 pump. Which is NOT to mean that I do not believe that Dexcom (and perhaps Tandem) are both stating you can not do that. However it is still be believe that Dexcom is wrong in their interpretation. Easy for me to say that as I am not on Medicare.

The Medicare Smartphone restriction (regardless of how one feels about that) is very specific and quite clearly spelled out. The same can not be said about any alleged restriction with the Tandem pump. If Medicare really wanted the pump to be restricted, they could have easily made it just as blatant and clear as they did for the Smartphone restriction. They fact that they did NOT do so indicates to me that there actually is NO Medicare restriction against the Tandem and this is simply a misinterpretation by Dexcom.

Also note that Diasend supports the upload of all data from the Tandem t:slim X2 pump including the integrated cgm data from the Dexcom G5.

That being said, any benefit from the Dexcom G5 integration with the Tandem t:slim X2 pump is currently minimal. The real benefit will be when Tandem gets the Basal-IQ (formerly PLGS) update FDA approved and released for remote download which is expected to be this summer.


#6

Feel free to ask any questions regarding the Dexcom and the Tandem. We played around with it quite a bit so have a pretty good feel for it.


#7

I found this site and it tell all about it!

Medicare, Dexcom G5, & Smartphone Access: Who’s to Blame and What Can We Do?

Medicare Refused to Cover CGM
WE ARE DPAC (Diabetes Patient Advocacy Coalition)


#8

@Daisy6
The article says the same thing I am saying although they reach a different conclusion.

Coverage of the CGM system supply allowance is limited to those therapeutic CGM systems where the beneficiary ONLY uses a receiver classified as DME to display glucose data.

The article also accurately copies the Medicare statement where they list examples of the non-DME devices they are talking about which are not allowed to be used. True these are examples and clearly not intended to be exhaustive but the list as provided:

(smart phone, tablet, etc.)

At which point, it would have been trivial to include “Pumps” or something similar if that truly was the intention of Medicare. They did not list such as I believe they had NO intention of excluding pumps. Medicare is clearly listing non-medical consumer electronic devices.

The Tandem t:slim X2 pump absolutely is Durable Medical Equipment (DME) by any definition I have heard of. This is why I say that there appears to be no specific prohibition against using the Tandem t:slim X2 as the receiver of the cgm data while operating integrated with the Dexcom G5.

I understand the writer of the article goes on to the next paragraph where they make the leap of faith that only the Dexcom Receiver can be used. However that is NOT what Medicare wrote. That link is simply implied by the writer. True, Dexcom also came to the same conclusion. I just disagree. However I am not on Medicare so I am simply a bystander with an opinion.

Bear in mind that Dexcom is absolutely advocating to have this restriction lifted. HOWEVER, (AFAIK) Dexcom is NOT advocating to simply allow the use of the Tandem Pump. Rather Dexcom wants the entire Smartphone restriction lifted to allow the Dexcom G5 Mobile App to be used. Which of course is great. But still (IMHO) has nothing to do with the Tandem Pump.

I still see nothing from Medicare which would reasonably lead me to believe that Medicare ever intended to restrict the Dexcom G5 cgm data from being received onto the Tandem t:slim X2 pump when running integrated.


#9

I guess I will be doing some more homework tomorrow, thanks for your input!


#10

I do know that Dexcom and Tandem share customer info. When I have a transmitter or sensor problem and Tandem replaces the parts, when I next call Dexcom they are aware of it. I do not however believe that customer data (via pump/cgm uploads) is being being shared between the 2 companies. I for one did not agree to that in the TOS when I downloaded T:Connect - I am weird and actually read every word. I also choose to “wash” my data and at the same time share it for research purposes by uploading to Tidepool.org. It’s free, I can get all the reports either on paper or pdf that my D-peeps need and neither Tandem or Dexcom can say anything about it. Medicare has absolutely ZERO access to it and it doesn’t display pump/cgm serial numbers on the reports.

@Tim35 also made a very pertinent comment IMHO - a pump is considered DME on every For Profit/HMO health plan in the US. Medicare also [covers pumps as DME] (https://www.medicare.gov/coverage/infusion-pumps.html) in part B. The Dexcom receiver is DME, and Medicare states you need a covered DME receiver. The pump is a DME receiver. If it wasn’t, you would be able to operate the Dexcom receiver and the pump receiver concurrently. To point, you can not. Neither receiver plays well with the other as they both want to be the ONLY receiver. They both play well with smartphone/watch apps, but not each other.

@Tim35 in my opinion is also correct that both companies are playing it safe by saying “no you can’t” because of perceived Medicare reimbursement rules.

JM2C


#11

Just got a G5 CGM under Medicare and it was made very clear to me that you can NOT use my X2 pump or smartphone with the G5. You also cannot use the clarity application on a smartphone. Dexcom Care has informed me today that I can install Clarity on my pc or laptop and upload my receiver numbers to the Clarity PC to share with my doctor.

As someone else said there are efforts underway to change this decision, but for now I am willing to use the receiver only to maintain Medicare coverage. It’s frustrating but the benefits outweighs the separate device.


#12

Your right Medicare won’t cover it.
My problem is now not only do I have to wear my pump but carry around the Dexcom receiver and your cell phone.
I have timers set on my phone going off, my pump is going off and the dam Dexcom is going off. I don’[t know if I’m coming or going.
I’m running out of pockets and hands! Right when you think you get the things you need and approved by Medicare they yank the carpet right from under you.
People, if your not on Medicare this does not apply to you only those who are on Medicare and your screwed if your on a pump.
This sucks!


#13

I am new to Dexcom. I am on Medicare and was told no cell/dex app but, I could download the receiver on to clarity (laptop) but I could use clarity also on my cell.
I think Dexcom Still are not clear.


#14

I don’t disagree with anything you’re saying, but have read something that the decision may change sometime during 2018. Who knows if that is right but it’s light at the end of the tunnel. In the meantime, having the flexibility of the Dexcom with Medicare coverage is worth it to me, hopefully for the short term.

I suspect part of the hang-up for Medicare is that there could be a large number of people that don’t have smartphones and they don’t want that to be a requirement/cost for CGM, hence requiring the receiver from Dexcom. Far cheaper than a smartphone. Perhaps if things were worded in such a way that the phone is a convenience option but not a requirement for the CGM, that might change the decision. Those without smartphones or integrated pumps could still use the Dexcom receiver. The ideal is integrated with the pump and capable of using the smartphone for sharing.


#15

You can use Clarity Reports Mobile on your cell. That’s different than the Dexcom G5 Mobile app.


#16

I received an email from Tandem a couple of weeks ago indicating that Medicare has approved the X2 pump to be used for viewing data from the G5. I started the same day and it is great. Email also said that G6 will start distribution for Medicare in April 2019.