Medicare

Does Medicare cover Dexcom G6?

Yes. The Dexcom G6 is available for patients who meet the Medicare coverage criteria. Dexcom G6 became available to new patients in October 2019. Existing patients will be eligible for an upgrade when their Dexcom G5 transmitter is out of warranty. The Dexcom G5 transmitter has a three-month warranty.

What patient information is required within chart notes to ensure eligibility along with CMS Medicare coverage criteria?

  • Has been seen in your clinic within the last 6 months
  • Has type 1 or type 2 diabetes
  • Performs frequent BGM testing (≥4x/day)
  • Uses an insulin pump or takes ≥3 daily injections of insulin
  • Requires frequent adjustments to their treatment regimen based on BGM or CGM testing results

For a complete description of Medicare coverage criteria and additional information related to what shold be included in the chart notes, please visit the Centers for Medicare and Medicaid services website

How can HCPs prescribe Dexcom G6 to their Medicare patients?

HCPs can send their patients to any Walgreens retail pharmacy via the following steps:

  • Prescribe to the patient’s preferred Walgreens location*
  • Walgreens will reach out to the HCP office for required documentation
  • Walgreens will follow-up with the patient to fill their prescription

*If a patient cannot or chooses not to fill their Dexcom G6 at a Walgreens, they go through one of the participating DME distributors listed on www.dexcom.com/medicare-coverage.

†If a patient does not live near a Walgreens, the HCP can prescribe to any Walgreens and the product will be shipped by mail at no cost.

For patients currently using Dexcom G6 who turn 65 (becoming Medicare-eligible), how will they be transitioned to Dexcom G6 for Medicare?

If a current Dexcom G6 patient “ages into” Medicare eligibility (i.e., turns 65), they will be treated as a new patient. Prescribers should follow the new patient process for Walgreens.

When will existing Medicare patients have access to Dexcom G6?

Medicare patients currently using Dexcom G5 will be automatically updated to Dexcom G6 when their G5 transmitter is out of warranty. This means they will automatically get a new Dexcom G6 transmitter and sensors with instructions on how to update the receiver and app. If they do not have a compatible receiver, they will get a new Dexcom G6 receiver.

Why can Medicare patients only fill their Dexcom G6 scripts at Walgreens? Will this change?

At launch, Walgreens is the only contracted retail pharmacy able to fulfill Medicare claims. Dexcom is working towards expanding the number of contracted pharmacies and will communicate additional access points when they become available.

What if the Medicare patient does not live near a Walgreens store?

If there is not a Walgreens in the patient’s area or they are unable to pick their script up for any reason, Walgreens will ship the Dexcom G6 and supplies directly to the patient. 

What if a patient does not want to go to Walgreens?

If a patient cannot or chooses not to fill their Dexcom G6 at a Walgreens, they will go through one of the participating distributors listed at www.dexcom.com/medicare-coverage. A member must call their plan to confirm that the supplier is in their network. 

What if the patient’s claim is denied at Walgreens?

If a Medicare patient is denied coverage for Dexcom G6, it will be the Walgreens pharmacy employee’s role to advise the patient or provider on the next steps for obtaining coverage.  

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