Paying for CGM


(clcapece) #1

Hi: I’m struggling with getting the Dexcom device covered by my insurance company and my doc thinks there might be a lower out of pocket cost for the Libre. I really want the Dexcom because it seems better, easier, etc. But i’m concerned about the cost. Anyone have any experience with this? How did you manage it?

Also, any insight on your experience with Dexcom vs Libre would be awesome. Thanks!

Carol


(Dennis J. Dacey, pwD) #2

Hi Carol @clcapece , I can definitely appreciate where you are at having wanted / needed a “non-passive” CGM but found the monthly cost to exceed my monthly Social Security - I put food and shelter on a priority over the monitor; I needed the non-passive with alarms because I had passed out a couple of times due to low BG. Thankfully CMS/Medicare was ordered to now provide CGM when a medical doctor prescribes it as “medical necessity”.
I understand the Libre is very good and the cost is less - will this be covered by your insurance? You would need to sacrifice the audible alarms which just in the past month have awakened me.


(jjmnav) #3

I like the active monitoring that Dexcom offers, alerting me WHEN going High or Low while Sleeping OR Awake and too busy to check the receiver every hour.
If you are stuck paying out of pocket (I am), I highly recommend dealing directly with Dexcom for (IMO) best available prices. Their Auto Ship program offers discounted prices on sensors AND free transmitter after every 9 shipments.


(ksannie) #4

My insurance used to cover Dexcoms when a patient had hypoglycemic unawareness. It took me awhile to get this information from the insurance company. But when I did, the appeal for coverage worked. I lost the sensation of low BG’s after about 15 years. I can now sometimes sense them, if I find I am confused while trying to do 2 things at once, but not always. Also, I do not wake up from low sugars unless my Dexcom wakens me. So it is a life-saving measure. Insurance may also cover it if you have high HbA1C’s. It is cost effective to have a sensor system warn you when you start to go high, so you can correct it. A lower HbA1C costs less because health problems and diabetes complications are lessened.


(Lori) #5

Dennis can you share where to find that Medicare was ordered to provide CGM when a doctor prescribes it as medically necessary? I’m fighting for Texas Medicaid to cover a CGM for my T1 15 yr old son. All amo I have ready for an appeal of a denial will be great!


(J) #6

Hi Jimnav,
I can only imagine how difficult hypoglycemic unawareness can be. That is part of my reason for using a cgm and pump. Why do some people have it right away and others never have it? I figure I will probably have it sometime soon since I’ve had T1D for so long. I have single-sided hearing loss, so if I sleep on my hearing ear side I miss the alarms. The vibration mode doesn’t wake me up.
Any suggestions on this problem?


(Dennis J. Dacey, pwD) #7

Lori @lvanroo van,
Here is the link to the initial CMS ruling: https://www.cms.gov/Regulations-and-Guidance/Guidance/Rulings/Downloads/CMS1682R.pdf
I don’t have any idea how or if it will work for your son under Texas Medicaid. Medicaid and Medicare, although they sound similar, are not the same animal. Another avenue you could peruse is through the CGM marketing staff and listen to their suggestions for getting coverage.
It takes time, for me, 18 months after the attached CMS ruling.


(BeccaGae) #8

Even though Medicare and Medicaid sound alike they are two separate beasts…
Medicare is for seniors 65+ and disabled individuals (comes from Social security/Centre for Medicare/Medicaid) and Medicaid is a joint federal/state programme so that is why it differs between states (states get to pick and choose what they will cover who they will cover, and how much they will cover).
MOST states flat out REFUSE to cover CGM’s for adults (I know Oregon DOES cover Dexcom and MiniMed’s CGM for adult), and some cover for children. Some cover pumps for adults and most cover for children (Oregon covers for both) (I don’t have medicaid but I know people who DO have it that ARE adults that do not have kids, that are on pumps and Dexcom and are not disabled).


(Janice) #9

I loved my Dexcom, wouldn’t use any thing else. Can your doctor put in for an exception? Check with Dexcom and see if they have a program that will allow you to use your Dexcom…Why doesn’t your ins, co want you to use Dexcom, can you appeal their decision? After all Medicare approves the use of the Dexcom CGM.


(jjmnav) #10

Sorry It’s been so long getting back. My hearing has never been as sensitive as some others I know. When sleeping I put my transmitter inside a pint canning jar (square vs round) with about a dozen coins on nightstand. The jar is laid on it’s side with opening facing the bed. It does make more racket than just setting the receiver on the nightstand. After a few years it does not always wake me up. so I intended to experiment with my son’s musical Cowbell but he sold it before I tried. Maybe I should try a small musical Cymbal.


(NickADOC) #11

This is a concerning pattern I’m seeing both here in my state and from others on these forums. Why do Insurance companies make it so difficult to get the technology and medicine that people with chronic illnesses need? Simple answer? Profit.

Only in America have I experienced a denial of Diabetes items because ‘it isn’t covered’ or the co-pay is too much.

It is time that the government and big pharma, stopped profiting out of our misery. Moving here was a big shock from the treatment I got from the NHS in UK.
It isn’t a perfect system but I never had to pay for any medicine or monitoring equipment I needed, I also got free eye tests and never had to wait too long for any treatments.

I would like to see the JDRF and the USDA work together to lobby government for better support and fairer pricing for all people with chronic conditions. There have been too many tragic stories of fellow sufferers not having access to the medication they desperately need, or even dying, all because they couldn’t afford their medication/insulin.
This is the actions of a developing world state!!

America constantly claims to be the best in the world as a country but doesn’t treat it’s own people, whom through no fault of their own, especially those with T1D, find themselves in a position of “do I buy insulin or do I feed myself?”

This is a shameful situation.

Rant over.


(Kristi) #12

I am in the same boat! I love my Libre, but have never gotten to try the Dexcom so can’t really compare the two. I definitely feel the out of pocket cost is lower for Libre. Have you tried having your doc write a letter of medical necessity? Maybe specifically laying out how the G6 requires no finger sticks and is so accurate that it can drastically improve A1C?


(Dennis J. Dacey, pwD) #13

Kristi @diabetictruths, don’t rely on the G6, or any other CGM or BGM, to lower your HbA1c.
The CGM and BGM and all the “fancy” insulin formulation are simply tools - some really awesome tools. To lower your A1c - and good diabetes management is much more than a particular A1c - takes effort on the part of the person with diabetes and an ability to read, interpret and take action on a daily basis of the information generated by these tools - as in the case of the DexCom G6, the really valuable dats displayed on the Clarity Reports.

I’ve successfully used a DexCom G5 to safely increase my A1c while significantly decreasing hypoglycemic events and lowering my CV. Yes, two endocrinologists, acting independently, ordered me a few years ago to increase my HbA1c by at least one half of one percent - now I’m up to a comfortable 6.3%.