Medicare patients eligible to receive reimbursement for Dexcom system


SAN DIEGO — The Dept. of Health and Human Services’ Centers for Medicaid and Medicare Services published an article clarifying that Medicare beneficiaries who previously struggled to control their diabetes will now be able to obtain reimbursement for the Dexcom G5 Mobile System.

According to Dexcom, its continuous glucose monitoring system (CGM) is proven to significantly lower A1C levels resulting in lowered medical costs from diabetes complications (e.g., ER visits, seizures, etc.) and is now the only device approved for CGM for Medicare.

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

As Drug Store News reported in January, the CMS previously classified the Dexcom system as “therapeutic,” meaning treatment decisions can be made using the device.

According to CMS, therapeutic CGM may be covered by Medicare when all of the following criteria are met:

  • The beneficiary has diabetes mellitus; and,

  • The beneficiary has been using a home blood glucose monitor (BGM) and performing frequent (four or more times a day) BGM testing; and,

  • The beneficiary is insulin-treated with multiple daily injections (MDI) of insulin or a continuous subcutaneous insulin infusion (CSII) pump; and,

  • The patient’s insulin treatment regimen requires frequent adjustment by the beneficiary on the basis of therapeutic CGM testing results.

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