Medicare and Dexcom G6: Yes!?!

There is a lot of discussion on social media this week about Dexcom G6 finally being available for Medicare recipients. Most of it is personal testimony along with a few links and guesses of what the story is. But some seniors are definitely ordering G6 systems and that is great news. I have heard from two sources that Dexcom will be sending current Medicare G5 users “A LETTER.” But now that the cat’s out of the bag, many of us are not patiently waiting for instructions from Dexcom.

The most information about G6 Medicare availability is on the Dexcom Provider website. This link details the steps a physician should go through to prescribe a G6 for Medicare patients:

https://provider.dexcom.com/support/medicare-coverage-and-prescribing-information

Interestingly Walgreen’s is being mentioned as the go-to supplier. Walgreen’s is licensed to dispense Part B DME for Medicare because that is how they have for many years provided test strips, insulin for pumps, and other DME products. Patients are also allowed to use other approved DME suppliers to get their Dexcom G6 and I have chosen to use Solara Medical which provides my pump supplies. Although I am mostly a satisfied Walgreen’s customer, they do periodically bill my Part B insulin to my Part D prescription plan and I don’t want to give them the chance to do the same with my CGM supplies. Hopefully the Dexcom-Walgreen’s partnership will be successful but I suspect it will take a while to work seamlessly.

Here are a couple more helpful links:

Medicare FAQ’s:  https://provider.dexcom.com/faqs-categories/medicare

DME suppliers other than Walgreens:  https://www.dexcom.com/medicare-coverage

I have no idea what the Dexcom letter will say or if there really is one. I do know that upgrade eligibility will require that it be at least 90 days since since the most recent G5 transmitter was shipped. I was somewhat concerned by the following statement on the provider FAQ’s webpage addressing existing Medicare patients: “New Medicare patients will have access to Dexcom G6 immediately, and we will begin upgrading existing Dexcom G5 Medicare patients soon.”

Since I have lived with Dexcom’s definitions of “soon” and “next quarter” for over a year, I was not willing to wait to see what happens. I called Solara this morning and a sales specialist placed my order. Solara will contact my endocrinologist for a prescription and the required chart notes. My last G5 transmitter shipped on August 6 and my G6 system should be eligible to be shipped on November 5. My G5 receiver is the old style and not able to be updated to G6. Therefore my initial G6 shipment will include a touchscreen receiver. Medicare regulations still require that a receiver be used occasionally to view Dexcom data although there is currently no enforcement of the policy. I think it is a “Don’t ask, Don’t tell” situation and a reflection of the fact that CMS has no interest in diving into the black hole of trying to update Medicare DME policies. Because Dexcom Clarity does reflect what devices I use to collect my CGM data, I try to use the receiver a day or two every couple of months. That seems “occasional” enough to me….

I am mostly happy with my Dexcom G5. But I use a Tandem pump and have been very frustrated at my inability to access Basal IQ because I don’t have a Dexcom G6. I truly believe that Basal IQ will improve my safety and sleep as it shuts off insulin delivery in response to predicted lows. Whether I use Basal IQ all of the time or just at night will be determined in the next couple of months. 

Nothing about this blogpost is official although it shares some legitimate facts through the Dexcom provider links. Other than that, it is what I have learned on Facebook from other Medicare Dex users and by talking with a sales rep at Solara Medical. Until a Dexcom G6 system arrives on my front porch, I will only hope that the road that I have chosen to G6 is a good one. If any of my readers has more information, opinions, or G6 experience, please share in the comments.

But I am smiling today because I was worried that today might never come….

13 thoughts on “Medicare and Dexcom G6: Yes!?!

  1. Good update Laddie. My time-frame for my last G5 transmitter is within days of what you noted above.
    I’ve also called my regional pump supplies ‘supplier’!! They have been quite busy and I had a good chat with one representative and he got the pertinent information from me and was going to have one of their CGM specialists call me back for granular detail and see about going from there.
    The rep did say that getting a good or expected supply of the G6 has been rough. He said often they will be expecting to receive XX number and they only get X number. He said it is and has been a supply issue from Dexcom. Likely due to the demand overall and manufacturing just might not be producing as many as needed or expected.
    We shall see as we proceed.

    • One reason I ordered today is that I didn’t want to wait until November and find out that they had no sensors to send. Hopefully I will have secured a place in line. TBD for sure.

  2. Oh that is wonderful news. I know it has been nothing but frustrating. I perosnally blame Dexcom for the delay. Lets face it had they said look there is no longer a G% to sell, medicare woudl have likely updated the coverage. But if Dexcom could ship it, under its previous contract, well we know medicare has never been about cutting edge technology. We will hope a lesson has been learned.

  3. I called my pump supplier (Diabetes Medical Supplies), was told that they are not providing the G6 due to lack of inventory, but she agreed to send a message to their Ordering Dept. to start my paperwork with the doctor so that when they do receive them I will be ready.

    • Estel – Do you actually mean Diabetes Management & Supplies out of New Orleans? If so that is what they told me yesterday. No inventory and shipments from Dexcom have been spotty. I’ve used DM&S for 4 years for my pump supplies.

  4. Hi Laddie. I’m getting mixed information from my supplier. First I was told that because my original receiver is not software upgradeable, I’ll have to wait until my three years is up (August 2020) before I can upgrade to the G6. Then on a callback, I was told they weren’t sure yet how the receiver upgrades were going to be handled, and they hopefully will know after November 1st, and they weren’t doing Medicare upgrades until then. So, I’m hanging. I’m due for a new transmitter the beginning of November, but I don’t want to get a G5 if I can get the G6 instead. This is all reminding me of what happened when Medicare first approved the G5. Same old thing. It was utter chaos with lots of different people saying different things. I do believe that Dexcom no longer wishes to deal with Medicare anymore.

    • Solara told me that I would get a receiver with my first G6 order and that Medicare would pay for it. We’ll all get it worked out eventually but it would be nice if there were clear facts and reliable information to help us navigate the road to G6….

  5. Hi, Laddie. Nice coverage of the G6/Medicare supply issue.

    Good luck with getting the G6 and finally gaining use of the Basal-IQ function from your pump. I used Solara for CGM supplies for several years until an insurance change and I found them to be dependable and consistent.

    I speculate that the G6 availability and slow/delayed rollout to Medicare beneficiaries is likely related to the large quantities of sensor replacements that Dexcom must backfill to people unable to get the full 10 days out of their initial sensor period. Mike Hoskins over at DiabetesMine is trialing the Basal-IQ system and in today’s (November 7, 2019) piece he also reports premature G6 sensor failures and requesting Dexcom replacements. I was hoping that issue would be sorted out before I arrived at that juncture but this concerns me.

    I’m happily hanging back with my trusty G4 setup and building up my G5 supply to cushion my landing when I’m scheduled to get the G6 next month from Byram

    Good luck with all your supply challenges!

  6. Dear Laddie, I am currently having to decide which new insulin pump to upgrade to. I see plus’s and negatives with the Medtronic and Tandem. I am leaning toward Medtronic 630G and adding a Dexcom sensor even though they do not link they are covered by Medicare. I have found Medtronic sensors painful and unreliable. My question is if I go with Tandem can I run the pump without wearing a sensor. I find wearing the sensor periodically and updating accordingly is enough to keep me in check for several months.

    Thank you for your contribution to Type 1s on Medicare.

    Lorraine

    • Lorraine-Yes, you can use the Tandem pump without a sensor and I am doing so right now. I originally left Medtronic because of their sensors many years ago and have been a Dexcom fan ever since. I have always chosen to use a Dexcom compatible pump although I have not always used my pump with Dexcom. But I like the option.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.