Currently, prescriptions for CGM devices covered by Medicare Part B are filled through Durable Medical Equipment suppliers, manufacturers or limited pharmacies, which can result in additional healthcare costs and delays in obtaining devices. With Walgreens new billing solution, patients who are prescribed the Dexcom G6 will be able to obtain the system quickly and conveniently at their local Walgreens pharmacy. Walgreens is also working with other CGM manufactures to incorporate their product into the new Medicare billing model.
“Leveraging Walgreens nationwide footprint and our expertise in providing medical billing solutions, we’re able to deliver a unique combination of personalized care and streamlined processes, making it easier for physicians and patients to prescribe and fill the Dexcom G6 at our stores,” said Rick Gates, senior vice president of pharmacy and healthcare, Walgreens. “This builds on Walgreens commitment to providing innovative solutions to simplify the customer experience and support patients managing chronic conditions, like diabetes.”
Earlier this year, Walgreens announced the expansion of the Walgreens Find Care™ platform to include Dexcom and additional connected devices and digital therapeutic solutions for patients with chronic conditions. On the Walgreens Find Care platform, diabetes patients can learn how to simplify and centralize critical health information with state-of-the-art health monitoring devices, like the Dexcom G6 CGM.
“Research continues to demonstrate CGM should be the standard of care for all diabetes patients on intensive insulin therapy,” said Kevin Sayer, executive chairman president and CEO of Dexcom. “Getting the Dexcom G6 into the hands of Medicare patients through Walgreens pharmacies is a significant step forward in increasing access to the most powerful diabetes management tool available.”
The Dexcom G6 uses a small, wearable sensor and transmitter to continuously measure and send glucose levels wirelessly to a smart device or receiver, giving patients real-time glucose data without the need to prick their finger. The system also offers customizable alerts and alarms to help avoid dangerous low and high blood sugar events and a function that allows patients to share their glucose data in real time with up to 10 followers.
Walgreens also accepts commercial insurance patients for all CGM devices, as well as Medicare Part B for select specialty medications and other blood glucose monitoring and supplies. Patients can get all their diabetes testing supplies at any neighborhood Walgreens store. Walgreens will bill Medicare Part B and qualified supplemental insurance, which means little or no out of pocket cost to patients.
About CGM and the Medicare Coverage Criteria
CGM devices are considered the most significant breakthrough in diabetes management in the past 40 years1 and Dexcom has been a leader of those innovations. Diabetes affects nearly 30 million Americans and is the seventh leading cause of death in the United States2. The traditional standard-of-care for glucose monitoring has been a fingerstick meter, which is painful as some patients needed to test their blood up to 12 times a day. CGM is important because, in addition to providing the glucose level, it provides the direction and rate of glucose change with the push of a button and alerts users when glucose levels are too low or too high. People with diabetes who take insulin must monitor their blood glucose levels frequently. Uncontrolled glucose can cause health complications and even death3,4.
People covered by Medicare who have either Type 1 or Type 2 diabetes and intensively manage their insulin are able to obtain reimbursement for the Dexcom G6. 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 beneficiary’s insulin treatment regimen requires frequent adjustment by the beneficiary on the basis of therapeutic CGM testing results; and,
- In six (6) months prior to ordering the CGM, the beneficiary had an in-person visit with the treating practitioner to evaluate their diabetes control and determine that the above criteria are met; and,
- Every six (6) months following the initial prescription of the CGM, the beneficiary has an in-person visit with the treating practitioner to assess adherence to their CGM regimen and diabetes treatment plan.
New Medicare patients can get started today with the system by talking to their doctor or visiting www.dexcomnow.com.
Walgreens (walgreens.com), one of the nation's largest drugstore chains, is included in the Retail Pharmacy USA Division of Walgreens Boots Alliance, Inc. (Nasdaq: WBA), a global leader in retail and wholesale pharmacy. Walgreens is proud to be a neighborhood health, beauty and retail destination supporting communities across the country, and was named to FORTUNE* magazine’s 2019 Companies that Change the World list. Approximately 8 million customers interact with Walgreens in stores and online each day. As of August 31, 2019, Walgreens operates 9,277 drugstores with a presence in all 50 states, the District of Columbia, Puerto Rico and the U.S. Virgin Islands, along with its omnichannel business, Walgreens.com. Walgreens also provides specialty pharmacy and mail services and offers in-store clinics and other health care services throughout the United States, most of which are operated by our health care strategic partners.
*© 2019, Fortune Media IP Limited. Used under license.
1. Clarke SF and Foster JR. A history of blood glucose meters and their role in self-monitoring of diabetes mellitus. Br J Biomed Sci. 2012;(3)2:83-93.
2. 2014 National Diabetes Statistics Report. Centers for Disease Control and Prevention. http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf. Accessed March 31, 2015.
3. Hyperglycemia (High blood glucose). American Diabetes Association Web site. http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/hyperglycemia.html. Updated August 5, 2013. Accessed December 3, 2013.
4. Hypoglycemia (Low blood glucose). American Diabetes Association Web site. http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/hypoglycemia-low-blood.html. Updated July 16, 2013. Accessed December 3, 2013.