Dexcom G7 is now
covered for all Medicare
patients on insulin*
Now more of your patients can experience the
life-changing benefits of Dexcom at no extra
cost compared to other CGM brands.†
New! Expanded
Medicare coverage
As of April 2023, Medicare now covers continuous glucose monitoring (CGM) for people who are on any type of insulin.* Even those who are not on insulin, but experience hypoglycemia events, can qualify for Dexcom CGM coverage.
Medicare eligibility criteria
Your Medicare patients may be eligible for Dexcom CGM if they meet the following criteria:
They have been diagnosed with diabetes
You have determined that the patient or their caregiver understands how to use CGM, and you have provided a prescription
The CGM is prescribed in accordance with an FDA indication for its use
The patient has been diagnosed with diabetes and meets one of the following criteria:
• Is treated with any insulin, or
• Has a history of problematic hypoglycemia, with documentation of at least one of the following:
• One or more Level 2 hypoglycemic events (glucose <54mg/dL) that persist despite one or more modifications of the diabetes treatment plan and/or adjustment of medication
OR
• One Level 3 hypoglycemic event (glucose <54mg/dL) characterized by altered mental and/or physical state requiring
third-party assistance for treatment of hypoglycemia
Patient has an in-person or Medicare-approved visit with the practitioner prescribing the CGM within 6 months of initiating CGM therapy
Patient has an in-person or Medicare-approved visit with the practitioner who prescribed the CGM every 6 months after initiating CGM therapy.
How to prescribe the Dexcom G7
CGM System for Medicare patients
Follow these two simple steps to get your eligible Medicare patients started quickly on the Dexcom G7 Continuous Glucose Monitoring System.
ENSURE THE CHART NOTES VERIFY THAT THE MEDICARE PATIENT MEETS THE CRITERIA ABOVE
SEND THE PRESCRIPTION TO ONE OF THE DISTRIBUTORS LISTED.
• Send the patient’s certificate of medical necessity (CMN) and chart notes to the distributor
• Let your patient know that they will be contacted by the distributor regarding their Dexcom G7 order
| DISTRIBUTOR | PHONE NUMBER | FAX NUMBER |
| Byram Healthcare | 800-775-4372 | 888-457-1277 |
| CCS Medical | 800-949-6481 | 800-557-8256 |
| Solara Medical Supplies | 800-423-0896 opt 2 | 800-999-7021 |
| Edgepark Medical Supplies | 866-400-5183 opt 2 | 866-510-6583 |
| Edwards Health Care Services | 888-344-3434 | 502-657-0237 |
| Advanced Diabetes Supply | 877-838-3026 | 760-444-8771 |
Dexcom CGM is an easier way to
manage diabetes without fingersticks.‡
91% of surveyed Medicare patients on
Dexcom CGM say it’s easy to use.1
4 out of 5 Medicare patients stay on Dexcom after 12 months.2
‡Fingersticks required for diabetes treatment decisions
if symptoms or expectations do not match readings.
Smart device sold separately.§
The American Association of Clinical Endocrinology (AACE) recommends real-time continuous glucose monitoring like Dexcom G7 for insulin-using adults ages 65 and older to achieve3:
- Improved glycemic control
- Reduced episodes of severe hypoglycemia
- Improved quality of life
Studies show that Dexcom CGM is
proven to increase time in range4-8
Studies show that Dexcom CGM use is clinically proven to increase time in range.4-8 Time in range is a powerful supplement to A1C because it shows a more complete picture of changes in glucose levels. Since A1C is a three-month average, it doesn’t give insight into potentially dangerous high and low glucose variations.
Retrospective review of glucose data from Dexcom G6 can identify patterns of hyper- and hypoglycemia, as well as glycemic excursions to help guide treatment decisions.
Case studies: Patients who can benefit from CGM
Below are some examples of patients living with type 1 and type 2 diabetes (T1D/T2D), each with different backgrounds and treatment plans. Read each scenario to learn how Dexcom CGM can help different patient types.
Hypothetical patient profiles
Patient background
Claudia, a 72-year-old female who lives alone and loves to garden. She has a history of level 3 hypoglycemia that required assistance.
Current treatment: Glipizide and metformin
Current A1C: 7.4%
Scenario
Claudia was planting flowers in her yard when she felt shaky and decided to sit down. A neighbor saw her sitting and looking disoriented and went over to see if she was ok. Claudia said she needed juice or the sugar tablets, which her neighbor quickly retrieved from her kitchen. She drank 4 ounces of juice and ate 2 glucose tabs. Once she felt a bit better, she realized she took her sulfonylurea at lunchtime but got sidetracked planting before she ate. She knew she had experienced very low glucose and decided to call her doctor to discuss.
She went in for an appointment the next day and told her doctor she’s had similar episodes before, and thinks she might have also been low those other times. Her doctor documented in the office visit note that Claudia has had level 3 hypoglycemia that required assistance, then prescribed Dexcom G7. She started on Dexcom G7 as soon as her shipment arrived.
Why Dexcom G7 was prescribed
Expanded Medicare coverage criteria* includes level 3 hypoglycemic events that require assistance and are documented in the office note.
How Dexcom CGM helped
Claudia now uses Dexcom G7 consistently and gets alerts if her glucose drops quickly or will be urgently low soon, so she can take action to avoid hypoglycemia. She also gets a low alert that she set to go off when she drops to 85 mg/dL.
Another feature of Dexcom G7 that Claudia says eases her mind and gives her comfort is that the Dexcom G7 mobile app allows her to share her CGM data with up to 10 followers.|| At this time, her neighbor and daughter follow her and get alerted if she is low so they can check in on her.
Patient background
Steve, a 68-year-old male who is very active. Despite being prescribed basal and mealtime insulin, he doesn’t take it due to fear of hypoglycemia.
Current treatment: Metformin, basal insulin (degludec), and meal-time insulin (lispro)
Current A1C: 8.9%
Scenario
Steve is competitive in tennis and teaches tennis lessons. He would run his glucose levels “really high” by not taking meal-time insulin due to fear of hypoglycemia while competing. Steve’s doctor asked him to check his glucose prior to tennis competitions and note what his numbers generally were. He was consistently over 300 mg/dL and comfortable with this because he knew he didn’t have to worry about having a low.
His doctor prescribed Dexcom G7, so Steve then had what he referred to as a “safety net” with the Urgent Low Soon and Falling Rate alerts. His first goal was for his glucose number to be less than 200 mg/dL prior to his competitions.
Why Dexcom G7 was prescribed
Expanded Medicare coverage criteria* includes anyone with diabetes treated with any insulin.
How Dexcom CGM helped
Steve was able to better manage his glucose levels prior to exercise and increase his time in range because he was ok starting tennis at a lower glucose level. He also has less frequent lows, because now he knows he can eat carbs when he gets an Urgent Low Soon alert. Dexcom G7 alerts help him worry less and feel better out on the court knowing he’ll get an alert if he is going too low.
This was a gradual process of adjusting his alerts and glucose goals. Once he started competing in a glucose range that wasn’t so high, Steve reported that he felt better and his performance improved. He also made other changes to food choices that he noticed were giving him high glucose after eating. Looking at trends and patterns on Dexcom Clarity reports¶ helps Steve see how much time he is spending in target range as well as where he could improve.
Patient background
Rebecca is a 67-year-old female who was diagnosed with T2D 12 years ago.
Current treatment: Metformin 1000 mg BID, Sitagliptin 100 mg QD, Glimepiride 4 mg BID, basal insulin (glargine) 36 units QPM
Current A1C: 9.8%
Scenario
Rebecca is motivated to manage diabetes but struggles with eating lower carbohydrate foods consistently. She’s busy with volunteering activities and her new post-retirement social life. When Rebecca was working, she kept her blood glucose meter at her desk and would check her glucose 1-3 times daily. Nowadays, she often forgets to bring the meter with her when she’s out and about.
Why Dexcom G7 was prescribed
Rebecca’s primary care provider (PCP) recognizes her desire to better manage her diabetes and wants to provide a tool that shows her glucose patterns and trends. Her PCP believes Rebecca can use that information to adjust her medications and improve overall glycemic management. In addition, expanded Medicare coverage criteria* includes anyone with diabetes treated with any type of insulin.
How Dexcom CGM helped
Glucose patterns and trends shown on Dexcom Clarity reports allowed Rebecca’s PCP to see what areas to improve and made medication adjustments to address her persistent evening and overnight hyperglycemia.# Her new medication plan included changing glimepiride to dapagliflozin (SGLT-2i), changing sitagliptin to semaglutide (GLP-1 RA) 0.25 mg titrated up to 1 mg weekly, continue on Dexcom G7, and follow up in 3 months.
At 3-month office visit, Rebecca’s A1C had decreased to 7.2% with improved postprandial hyperglycemia. Her Dexcom Clarity reports showed overnight hypoglycemia and glycemic variability. Her PCP recommended reducing her basal insulin to 18 units QPM and continuing with lifestyle modifications. Rebecca is now using Dexcom G7 to guide meal choices and thanks to Dexcom G7 alerts, she can intervene earlier to prevent or minimize hypoglycemia episodes.
Patient background
Doug is a 68-year-old male who was diagnosed with type 1 diabetes 47 years ago.
Current treatment: Degludec 40 units daily at bedtime, Aspart 1 unit per 10 grams carbohydrate plus correction of 1 unit per 50 mg/dL over 150 mg/dL at meals
Current A1C: 7.2%
Scenario
Doug has been living with type 1 diabetes since early adulthood when he was diagnosed. He has been on multiple daily insulin injections and using a blood glucose meter (BGM) to check his glucose numbers since diagnosis and his outlook is, “if it’s working, why change what I’m doing?” Doug eats well-balanced meals and feels he’s doing everything he can to take care of his diabetes.
Sometimes, Doug is unsure if he is experiencing hypoglycemia and it worries his wife that he’s not as aware of the symptoms as he used to be. He is stubbornly independent and doesn’t want much help from others, especially when it comes to diabetes management.
Why Dexcom G7 was prescribed
Doug told his primary care provider that he feels like his glucose numbers aren’t as steady as they used to be, and he can’t figure out why. His doctor told him that Dexcom CGM could give them both insight into what’s happening with his glucose levels in between fingerstick checks with his BGM.
Doug was curious to see how CGM could help, and decided to give it a try since it’s covered by Medicare.*
How Dexcom CGM helped
For the first time since being diagnosed, Doug was able to get a clearer picture of what was happening with his glucose levels throughout the day and night. He had no idea that eating oatmeal with banana slices for breakfast caused his glucose to spike to over 250 mg/dL, and it took a few hours to get back in range.
Before CGM, Doug only saw the numbers in the low 100s before he ate and the 100s before lunch. Doug admits, “I was under the impression that all my blood sugars were in range based on the numbers I was seeing on my meter, and my A1C being around 7%. I can now see that I have some pretty big spikes after what I thought were healthy meals. I’m going to experiment to see what I can eat for breakfast that won’t cause such a spike.” Doug was surprised that he felt comfort in being able to always see his current glucose number and the direction it’s heading. This caused him to worry less when he was busy and not wanting to interrupt his day to use his BGM.
Doug’s wife was glad he eventually allowed her to follow his Dexcom G7 data and be alerted if he gets an Urgent Low Alarm. Doug likes that he can decide what alerts his wife receives, and that she’s not nagging him as much about his numbers because she can see them on the Dexcom Follow app.¶
In order to qualify for Medicare coverage for Dexcom G7 supplies, Medicare requires that they have a receiver that is compatible with Dexcom G7 and that they use that receiver with their supplies, even if they also use a compatible smart device, regardless of whether they use an insulin pump. If Medicare does not pay for a new receiver, Dexcom has launched a new upgrade program that includes a Dexcom G7 receiver at no charge for eligible customers.
The two receivers have different hardware.* Please refer to the user guides for information about the hardware.
|
|
| Current Dexcom G6 Touchscreen Receiver | New Dexcom G6/G7 Receiver |
* Please note that images are not to scale.
The Current Dexcom G6 Touchscreen Receiver can not be upgraded to G7.
The New Dexcom G6 Touchscreen Receiver can be upgraded from G6 to G7.
Please reference Current Dexcom G6 Touchscreen Receiver user-guide here.
Please reference New Dexcom G6 Receiver user guide here.
Please reference New Dexcom G7 Receiver user guide here.
Medicare requires the use of the receiver for all patients. For all other payers, patients have the choice of what device to view their numbers. Users can also view their numbers on both their phone* and receiver if they choose.
Yes, the new Dexcom G6 receiver can be upgraded from the G6 to the G7 CGM system once your patient has a G7 prescription and has received the product. To upgrade, please instruct your patient to first use a secure internet connection to upload his/her G6 data to clarity.dexcom.com by logging in with his/her Dexcom account information and clicking Upload. Then, Clarity will ask if he/she wants to upgrade the receiver from G6 to G7. Just click the boxes to confirm that all the requirements are met. Please note that by upgrading the receiver from G6 to G7 your patient will no longer be able to use Dexcom G6 sensors or transmitters with the new Dexcom G6 receiver and your patient will not be able to revert the receiver back to G6. Your patient may opt to update from G6 to G7 any time he/she chooses, just return to Clarity and upload to be asked again.
Dexcom G6 and Dexcom G7 are available to Medicare patients through a medical distributor (see distributor list below).
Your patients may call a distributor from the list below to start the ordering process.
If your patient uses a connected insulin pump or pen,|| we recommend they continue using Dexcom G6 until our insulin delivery partners integrate with Dexcom G7.
| Distributor | Phone | Fax |
| Advanced Diabetes Supply | 877-838-3026 | 760-444-8771 |
| Byram Healthcare | 800-775-4372 | 888-457-1277 |
| CCS Medical | 800-949-6481 | 866-823-4482 |
| Diabetes Management & Supplies | 888-738-7929 | 504-734-7165 |
| Edgepark | 866-400-5183 | 866-510-6583 |
| Edwards Healthcare | 888-344-3434 | 502-657-0237 |
| Solara Medical Supplies | 800-423-0896 option 2 | 800-999-7021 |
| US Medical | 877-659-9875 | 888-659-9112 |
Medicare beneficiaries with diabetes mellitus who are using any kind of insulin will be eligible for CGMs. Frequent adjustment of insulin on the basis of CGM results is no longer required. The beneficiary must simply be insulin-treated.
For a full description of coverage criteria, Click HERE
If your patients are current G6 users, please contact your distributor for pricing and upgrading options to Dexcom G7. If your patients currently use Dexcom G6 with a connected insulin pump, we recommend continuing it until Dexcom G7 adds compatibility with your pump or pen. We're working with our insulin delivery partners to integrate with Dexcom G7 as soon as possible. Medicare covers one CGM receiver every five years.
Dexcom has a discounted receiver program through GoodRx for getting a G7 receiver at an affordable price. Visit the Dexcom Savings Center for more information. Terms and conditions apply.
Dexcom G6 and Dexcom G7 are available to Medicare patients through a medical distributor (see distributor list below).
Your patients may call a distributor from the list below to start the ordering process.
If your patient uses a connected insulin pump or pen, we recommend they continue using Dexcom G6 until our insulin delivery partners integrate with Dexcom G7.
|
Distributor |
Phone Number |
|
Advanced Diabetes Supplies |
877-838-3026 |
|
Byram Healthcare |
800-775-4372 |
|
CCS Medical |
800-949-6481 |
|
Diabetes Management & Supplies |
888-738-7929 |
|
Edgepark |
866-400-5183 |
|
Edwards Healthcare |
888-344-3434 |
|
Solara Medical Supplies |
800-423-0896 option 2 |
|
US Medical |
877-659-9875 |
No. Blood glucose monitoring (BGM) supplies are not included in the CGM product shipments because Dexcom G6 and Dexcom G7 do not require fingerstick calibrations.* Any BGM testing supplies need to be purchased.
*If your patient’s glucose alerts and readings from the Dexcom G6 or Dexcom G7 do not match symptoms or expectations, please use a blood glucose meter to make diabetes treatment decisions.
How does my patient view glucose data?
You can view your patient’s glucose data through the Dexcom G6 or Dexcom G7 Apps, your Dexcom G6 or Dexcom G7 receiver, and the Clarity Mobile or Desktop applications.
Medicare does not cover Dexcom G6 or Dexcom G7 CGM supplies that are used only with a smartphone or other mobile device. Failure to use your receiver will result in loss of Medicare coverage for your Dexcom G6 or Dexcom G7 CGM supplies.
Coverage of CGM system supplies and accessories are available for those therapeutic CGM systems where the beneficiary uses a receiver classified as DME to display glucose data. There is no Medicare benefit for supplies used with equipment that is not classified as DME. However, Medicare coverage is available for the CGM system supplies and accessories if a non-DME device (smartphone, smart watch, tablet, etc.) is used in conjunction with the durable CGM receiver. Coverage of CGM system supplies and accessories are available for those therapeutic CGM systems where the beneficiary uses a receiver classified as DME to display glucose data. If a beneficiary intends to never use a receiver classified as DME as the display device, the supplies and accessories are not covered by Medicare.
Here are some examples of how a Medicare patient may use a smart device with their receiver:
-
A patient uses both a receiver and a smartphone throughout the day
-
A patient uses a receiver some days and their smartphone other days
Patients should reach out to 1-800-MEDICARE with any questions about the Medicare coverage requirements for Dexcom CGM.
Generally, Medicare patients pay 20% out of pocket. Many Medicare beneficiaries have supplemental insurance coverage such as Medigap that covers their out-of-pocket costs.
Visit www.dexcom.com/medicare to view online training videos. These videos can walk your patients through the steps to get started, including receiver and app set-up, and downloading Dexcom CLARITY
Still need help? Call Dexcom Product Education & Training to speak with a Diabetes Coach at 877-339-2664.
For technical troubleshooting, our specialists are available 24/7 at 844-607-8398.
*Medicare covers Dexcom CGM for patients who meet the Medicare coverage criteria. For a list of Medicare coverage criteria, please visit the Center for Medicare and Medicaid services website. †Under Medicare’s DME fee schedule, reimbursement, and coinsurance for CGMs using CPT codes A4239 and E2103 are the same, regardless of CGM brand. §For Medicare coverage of Continuous Glucose Monitoring (CGM), CMS requires use of a receiver. A patient may use a compatible smart device in conjunction with a receiver: dexcom.com/compatibility. ||Separate Dexcom Follow app and internet connection required. ¶An internet connection is required to send data to Dexcom Clarity. #Patient must first sync their Dexcom CGM data with the Dexcom Clarity app and consent to share their data with their healthcare provider. **To learn more about insulin pump integrations and compatibility with Dexcom CGM Systems, visit dexcom.com/integrate.
1 Qualtrax Data - Q1 2023. 2 Dexcom, Data on File, 2023. 3 Grunberger G, et al. Endocrine Practice. 2021;27(6):505-537. 4 Beck RW, et al. JAMA. 2017;317(4):371-378. 5 Beck RW, et al. Ann Intern Med. 2017;167(6):365-374. 6 Martens T, et al. JAMA. 2021;325(22):2262-2272. 7 Laffel LM, et al. JAMA. 2020;323(23):2388-2396. 8 Welsh JB, et al. J Diabetes Sci Technol. 2022:19322968221099879.
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