Dexcom Now Shipping CGM to Medicare Beneficiaries

After hitting a few snags and finding a partner to create the bundle needed for Medicare shipping requirements, Dexcom is now shipping the Dexcom G5 to beneficiaries who meet criteria for coverage for continuous glucose monitoring (CGM).

A 2-step process over the past year allowed Medicare patients to gain access to CGM, after years of work by advocacy groups, physicians, patients, and members of Congress. First, FDA updated the Dexcom G5 approval to include dosing, which paved the way for CMS to add the Dexcom G5 to its schedule of durable medical equipment. Dexcom’s G5 is the only CGM system approved for therapeutic use, which means patients need the system to maintain glycemic control.

It wasn’t that easy at first. Dexcom had to find a partner in Ascensia, which provides the blood glucose monitoring system that beneficiaries will use twice a day to calibrate the CGM. Per Medicare rules, the products had to be shipped together. That agreement was reached in early July.

Demand among beneficiaries is so high that 20,000 Medicare patients are currently in the pipeline for CGM before Dexcom has done any major promotion of the change of Medicare policy, spokeswoman Julia Yuryev said in an e-mail to The American Journal of Managed Care^®.

In total, 800,000 seniors are eligible for CGM, including virtually all Medicare beneficiaries with type 1 diabetes (T1D), and those with type 2 diabetes (T2D) who are on intensive insulin therapy and have been performing blood glucose tests at least 4 times a day.

Yuryev said Dexcom has hired and trained a dedicated team of Medicare sales and support staff for beneficiaries who are assisting existing Dexcom CGM patients, following by new patients in the order their requests were received.

To be eligible for reimbursement, Medicare requires specific documentation from physicians in patient medical records. The following must be documented:

• The patient has diabetes.
• The patient has been using a home blood glucose monitor (BGM) and has been performing BGM testing at least 4 times a day.
• The patient is treated with 3 or more daily injections of insulin or a continuous subcutaneous insulin infusion pump.
• The patient’s insulin treatment regimen requires the patient to make frequent adjustments based on therapeutic CGM testing results.
• Six months before ordering the CGM, the patient must make an in-person visit to his or her physician to evaluate glycemic control and determine that the criteria are met.
• Every 6 months after the initial prescription for the CGM, the patient must see his or her treating physician to assess adherence to the CGM regimen and the diabetes treatment plan.

Failure to meet the criteria mean Medicare will not pay for the Dexcom G5 or the supplies, giving patients a strong incentive to have good adherence.