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Medicare to Reimburse for Dexcom G5 Mobile CGM for Type 1 and Type 2 Diabetes

Frequent blood glucose testing can be expensive, especially for individuals who must intensively manage their insulin and adjust dosages. The cost of supplies can add up, but they are a necessity for good health. Some individuals may soon see some relief as Medicare recently agreed to cover therapeutic continuous glucose monitoring (CGM) systems and provide reimbursement. The Dexcom G5 Mobile CGM is currently the only system approved by the FDA for making treatment decisions that falls under this coverage.

Reimbursement would be available for individuals on intensive insulin therapy (either through multiple daily injections or a CSII pump) with Type 1 or Type 2 diabetes. Given current estimates of the number of intensive insulin users receiving Medicare, this could mean that more than 1 million people could be eligible for CGM coverage.  Reimbursement would include not only the G5 receiver, but also sensors, transmitters, and BGM and related supplies.

Dexcom CEO Kevin Sayer explains, “This is a new era and a huge win for people with diabetes on Medicare who can benefit from therapeutic CGM. This decision supports the emerging consensus that CGM is the standard of care for any patient on intensive insulin therapy, regardless of age.”

The broad scope of coverage criteria could mean that even more individuals may be eligible for coverage than previously thought. According to Dexcom, criteria includes:

  • Have diabetes;
  • Have been using a home BGM and performing at least four checks per day;
  • Are insulin-treated with MDI or a pump; and
  • Have an insulin treatment regimen that requires frequent adjustment on the basis of therapeutic CGM testing results.

The Dexcom G5 Mobile is categorized as “Durable Medical Equipment” under Medicare Part B, and qualifies as therapeutic CGM because it can be used to make treatment decisions. In addition, the system’s non-adjunctive label claim was approved in December. The ruling regarding coverage moved forward very quickly, and is a step forward for individuals living with diabetes.

There are currently other CGM systems on the market, but they have not yet been approved by the FDA as therapeutic CGM, therefore are not subject to coverage at this time.

The Diabetes Research Connection is excited to see how this will impact patients with diabetes moving forward. The organization strives to enhance research into the prevention, treatment, and cure of Type 1 diabetes through donor-driven funding. To learn more and support emerging research, visit www.diabetesresearchconnection.org.

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