Abbott's Freestyle Libre Cgm Device Wins Medicare Coverage
An employee walks near an Abbott Laboratories sign at the company's headquarters complex in Abbott Park, Illinois. Its FreeStyle Libre continuous glucose monitor received Medicare coverage, one month after it was launched, the company said Thursday. The decision comes and between 9 and 12 months ahead of Wall Street's expectations, J.P. Morgan analyst Michael Weinstein wrote in a note following the announcement. The product is the first continuous glucose monitor on the market that doesn't require patients to prick their finger to draw blood. Analysts had expected Abbott to gain from FreeStyle Libre even before Thursday's announcement because the company is aggressively pricing and marketing the new technology. Yet they saw limits from patients having to pay for it out-of-pocket while Abbott waited for coverage approval from insurance companies and the Centers for Medicare & Medicaid Services. CMS oversees federal health programs such as Medicare and Medicaid. J.P. Morgan on Tuesday had estimated FreeStyle Libre to generate $68 million in sales in 2018, with upside up to about $100 million if Abbott secured either commercial reimbursement, Medicare reimbursement, or labeling for kids earlier than expected. The announcement pits Abbott against rival Dexcom in the battle for Medicare patients. Dexcom's G5 system requires calibration, while Abbott's does not. Dexcom expects to introduce its own system that doesn't require fingerstick testing by the end of the year. Medicare patients will choose between Abbott's FreeStyle Libre and Dexcom's G5 based on features and ease of use because the cost is the same, Weinstein wrote. Dexcom's device has Bluetooth connectivity, but the feature isn't available for Medicare patients. "So for elderly Medicare patients, the choice is the Continue reading >>
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Blood Glucose Meter & Insurance Coverage
Different plans cover varying amounts of the meter/ strips; there are exceptions to the list below. Many plans cover strips through prescription plans so be sure to verify prescription plan coverage. Sometime it’s more cost effective through DME (durable medical equipment) so individual should check his/ her coverage. Also, some meter companies offer discount cards so it may be more cost effective to use the copay card instead of the recommendations below. Abbott/Freestyle is now available with automatic lower copays for all commercial plans at participating pharmacies (CVS, Rite Aid, Walmart, Walgreens, Giant, Costco, Wegman’s). Recommended meters by each company: Abbott - Freestyle Freedom, Freestyle Lite, Freestyle Insulinx, or Precision x-tra Accu-chek - Guide, Nano, Aviva or Compact Plus Bayer - Contour, Contour Next, Contour USB, or Breeze 2 One Touch - Verio, Ultra, Ultra 2, Ultra Smart, Ultra Mini Continue reading >>
Diabetic Meters Approved By Medicare
It's an honor that you've allowed us to try and help with your family and life issues. Thank you very much for visiting. Please return soon. Help to get Medicare approved diabetic meters, testing supplies and more. Learn how to choose a meter, what Medicare needs and handy sources of diabetes information. While most pages under this title are diabetic services companies looking for business, this page is to help you get your diabetes testing supplies through your doctor and Medicare without needing the third party. You'll learn how to get Medicare approval, how to choose a meter, handy Medicare Information phone numbers and more. What Meters Are Approved By Medicare? After searching for hours under Medicare Parts B and D, to get a list of approved meters, It hit me. Medicare Part B appears to pay 80% for any meter your doctor prescribes, along with the related lancets and test strips. If you're diagnosed with diabetes and prescribed a meter, Medicare covers it. Most meters are free, whether or not Medicare covers them. The details Medicare needs about your monitoring equipment, lancets and test strips are covered in the next section. Near the bottom of the page, I've listed a few handy diabetes information sources if you have any questions. What Medicare Needs To Approve A Meter: Medicare needs a prescription from your doctor in order to approve your glucose meter, test strips and lancets. The prescription needs to specify that you have diabetes, the kind of meter you need and why, whether you use insulin, how often you should test your blood sugar and how many strips and lancets you'll need each month. Some of these prescriptions must be renewed yearly. You can pick up your supplies at any Medicare enrolled pharmacy or have them delivered by a Medicare enrolled medical Continue reading >>
Medicare Coverage For Contour Next And Breeze Meters | Contour Next
Important note: A doctor's prescription is required for Medicare reimbursement. If your doctor recommends that you test more often than Medicare's guidelines permit, your doctor can authorize you to receive more self-testing supplies which Medicare will cover after additional requirements are met. For more information, check with your doctor and/or medicare.gov . What is Medicare's Competitive Bidding Program? Congress passed a law requiring Medicare to implement a Competitive Bidding Program for certain durable medical equipment, prosthetics, orthotics and supplies (DMEPOS). The program changes the amount Medicare pays suppliers for DMEPOS supplies and changes who can provide these items to Medicare beneficiaries. Under this program, suppliers submit bids to furnish certain DMEPOS products to Medicare beneficiaries. Based upon the bids, Medicare determines the amount it will pay for the supplies and selects the suppliers who can provide the products. Has the Competitive Bidding Program started? The competitive bidding program started on July 1, 2013. Reimbursement amounts for suppliers changed at this time to the amounts achieved through the bidding program. If you currently receive your CONTOURNEXT, CONTOUR or BREEZE2 from a mail order supplier, and your current mail order supplier was not selected as a "winner" by Medicare, you may need to find a new Medicare "contracted" mail order supplier or you may purchase your CONTOURNEXT, CONTOUR or BREEZE2 at a local pharmacy. Are diabetes testing self-supplies included in the program? Yes, but only for diabetes self-monitoring testing supplies delivered through the mail. This program does not affect diabetes testing supplies purchased at retail pharmacies. Are CONTOURNEXT,CONTOUR or BREEZE2 diabetes self-monitoring testing Continue reading >>
Prodigy® Diabetic Supplies – Medicare And Insurance Coverage
Blood glucose testing is an important part of diabetes management. Most insurance companies and Medicare/Medicaid will pay for blood glucose testing supplies. With private insurance or managed care, patients will most likely be asked to pay a co-pay to cover part of the cost of the supplies. Medicare pays for 80% of supplies once the patient has met their yearly deductible and the patient is responsible for the remaining 20% of the cost. See the www.Medicare.gov site for a full explanation of how your blood glucose testing supplies are covered. Prodigy Diabetes Care is contracted with certain insurance providers and state Medicaid programs, which may make the Prodigy brand products available to those individuals at a lower co-pay or no co-pay depending on the program. Continue reading >>
When you have diabetes, accuracy matters. Stick with the brand you trust—don't let them switch your test strips! Some test strip suppliers may tell you otherwise, but Accu-Chek products are still covered by Medicare Part B at the same low co-pay1 as all other brands.2 They may even try switching you to another brand. They’re not concerned about you—they’re doing it to benefit their own bottom line. You can take some simple steps to preserve your choice and ensure you’re not switched to a low-quality product: Say "no," if your strip supplier tries to switch you to another brand. At your next visit, ask your doctor to specify Accu-Chek test strips by name on your prescription. Ask for Accu-Chek strips by name from your test strip supplier. If they no longer carry Accu-Chek test strips, you can purchase them from local retail pharmacies. For a list of retailers that offer Accu-Chek products, visit our Where to Buy page. Get smart answers about Medicare changes Medicare has changed how mail-order customers get diabetes testing supplies. Here's what it means for you. What if my mail-order supplier tells me I need to switch to another brand? You do NOT have to change brands. Patient protection rules exist to help ensure that you have access to the supplies you know and prefer to use. The anti-switching rule requires contract suppliers to furnish the brand of testing supplies that work with the monitor currently in use by the patient. It was established to protect patient and physician choice of glucose monitors. If the supplier you contacted doesn't carry Accu-Chek products, visit your local retailer to purchase your Accu-Chek test strips. Am I required to get my strips through mail order? No. Medicare Part B patients can get diabetes testing supplies from a retail Continue reading >>
What Diabetic Supplies Are Covered By Medicare? - Medicare Faqs
What Diabetic Supplies Are Covered by Original Medicare? Original Medicare Part B covers some diabetic supplies, including: Blood glucose monitors, lancet devices, and lancets Glucose control solutions for checking the accuracy of test strips and monitors Insulin if you are using a medically necessary insulin pump (see below) There may be coverage limits on the quantity and frequency you can get these supplies. Original Medicare Part B does not cover these diabetic supplies: Insulin (unless used with an insulin pump) If you use a medically necessary external insulin pump, the insulin and the pump could be covered as durable medical equipment (DME). If you do not use a pump, you pay for all of your insulin costs. If you have Medicare prescription drug coverage (Medicare Part D), insulin and certain medical supplies used to inject insulin are covered. Medicare Part B coverage includes therapeutic shoes or inserts fordiabeticswho have certain conditions ask the doctor who treats your diabetes if you need them. To make sure these supplies are covered by Medicare, please note: A qualified doctor (such as a podiatrist) must prescribe the shoes or inserts. A qualified doctor (such as an orthodontist) must provide and fit you for the shoes or inserts. Medicare Part B covers one pair of custom-molded shoes (including inserts) or one pair of depth-inlay shoes per calendar year. Medicare also covers two additional pairs of inserts each calendar year for custom-molded shoes and three pairs of inserts each calendar year for depth-inlay shoes. In certain cases, shoe modifications may be substituted for inserts. The supplier must have an order (prescription) on file signed and dated by the treating doctor; if you switch to a different supplier, you may need to have your prescription Continue reading >>
Medicare Coverage For Continuous Glucose Monitors
Medicare Coverage for Continuous Glucose Monitors Download a full chart of continuous glucose monitors (CGMs) and their features. Until about a year ago, people with diabetes who used a continuous glucose monitor (CGM) lost coverage once they went on Medicare. For those diagnosed after they went on Medicare, a CGM wasnt an option. The only solution? Pay for the device out of pocket or dont use one at all. Now, two CGM systemsDexcoms G5 Mobile and Abbotts FreeStyle Libreare covered as durable medical equipment under Medicare Part B for beneficiaries with type 1 or type 2 diabetes who take multiple daily insulin doses and who make frequent adjustments to those doses. The Dexcom G5 Mobilelike most other CGMsconsists of three parts. A sensor is inserted just under the skin, continuously monitoring glucose for up to a week; a transmitter attaches to the sensor and sends readings to a receiver or insulin pump; and a wireless receiver, smartphone, or pump displays the glucose readings. The system tells users whether their glucose levels are steady, rising, or fallingand how quickly. It also alerts users when their level rises too high or drops too low. (Those values are determined by the user, with help from a doctor, and are programmed into the system.) The FreeStyle Libre works in a slightly different way. A sensor, worn on the upper arm for up to 10 days, collects glucose data from just below the skin. Users move a reader device, which looks like a large glucose meter, over the sensor to check their glucose level. Like traditional CGMs, the FreeStyle Libre displays whether a persons glucose is rising, falling, or staying steady, but the device doesnt deliver alerts when levels go out of range. On the upside, the FreeStyle Libre doesnt require calibrations using finger-stic Continue reading >>
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Dexcom G5 Cgm System Is Now Covered Under Medicare
Who is covered under Medicare? 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 3 or more daily injections (MDI) of insulin or a continuous subcutaneous insulin infusion (CSII) pump; and, The beneficiary's insulin treatment regimen requires frequent adjustments by the beneficiary on the basis of therapeutic CGM testing results. Within 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. In order to be included in this category, the system must be defined as therapeutic CGM, meaning you can make treatment decisions using the device. Dexcom G5 CGM System is the only system approved by the FDA to meet that criteria. Note: Under the current ruling, the beneficiary may NOT use their smart phone to display glucose data and still be eligible for reimbursement for the purchase of a therapeutic CGM: you cannot use the Dexcom CGM app to display glucose data and be eligible for reimbursement from Medicare. Continue reading >>
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Newsflash: Medicare Can Cover Some Cgms Now!
Huuuuge news in the Diabetes Community!!! In a surprise move late last week, the Centers for Medicare and Medicaid Services (CMS) issued a policy decision allowing for certain continuous glucose monitors (CGM) to be covered under Medicare! This important 16-page ruling on Jan. 12 came after business hours on the East Coast, and it was the JDRF -- one of the organizations that's led advocacy efforts on this issue for several years -- that put the word out right away among the D-Community. There are several reasons why this is a really big deal: CGM is a powerful therapy tool, one that can in particular save lives of people who experience hypoglycemia unawareness, or have dramatic highs and lows. SO naturally, it should be covered by insurance With Medicare refusing to cover it, patients using CGM who hit Medicare age were suddenly losing access to this important tool, which is nonsensical and frankly, unethical Classifying CGM as core therapy rather than "supplemental" paves the way not only for broader coverage of CGM across the board, but also for Artificial Pancreas systems on the near horizon What Exactly Has Changed: Up until now, CMS has considered CGM technology to be "precautionary," meaning it was classified as a supplemental type of device that wasn't medically necessary. CGM also didn't fall under the "Durable Medical Equipment" category that covers other diabetes devices and supplies, therefore it wasn't eligible for Medicare coverage. That now changes. A critical step that led to this CMS decision was the FDA's ruling in December that the Dexcom G5 specifically is accurate enough to be used for insulin dosing and treatment decisions. Thanks to that landmark FDA decision, the Medicare and Medicaid agency could now consider CGM "therapeutic" and classify it as Continue reading >>
Diabetes Supplies, What Medicare Covers
HEALTH FEATURE ARCHIVE Diabetes Supplies: What Medicare Covers 1. Self-testing equipment and supplies: Medicare Part B covered diabetes supplies: Coverage for glucose monitors, test strips, and lancets. Who is covered: All people with Medicare who have diabetes (insulin users and non-users). Medicare covers the same supplies for people with diabetes whether or not they use insulin. These include glucose testing monitors, blood glucose test strips, lancet devices and lancets, and glucose control solutions. There may be some limits on supplies or how often you get them. For more information about diabetic supplies, call your Durable Medical Equipment Regional Carrier. How to get your diabetes equipment and supplies: To get your diabetes equipment and supplies under Medicare, you need a prescription from your doctor. The prescription should say: You have been diagnosed with diabetes. How many test strips and lancets you need in a month. What kind of meter you need. For example, if you need a special meter for vision problems, the doctor should say that and state the medical reason why you need a special meter. Whether you use insulin or not. How often you should test your blood sugar. Points to remember: Ask your doctor or health care provider if regular blood sugar testing is right for you. You need a prescription from your doctor to get your diabetes equipment and supplies under Medicare. Learn the correct way to use your blood sugar meter properly. Your pharmacist, doctor, diabetes educator, or another health care provider can help you. Keep track of your blood sugar readings and share them with your doctor or health care provider at regular visits. Do not accept shipments of diabetes equipment and supplies that you did not ask for. 2. Therapeutic shoes: Medicare also c Continue reading >>
Medicare Told To Cover Cgms In Ruling
Two judges say the device is necessary, not precautionary. Will this end the debate? Medicare doesn’t typically provide coverage for continuous glucose monitors (CGMs), as insurors who oversee Medicare coverage have long argued that CGMs are a “precautionary” device rather than a “medically necessary” one. Now, that argument’s premise is facing serious questions in federal court and in the Medicare appeals process. The first case that successfully pushed back against the policy involved Wisconsin resident Jill Whitcomb, who has had Type 1 diabetes for 40 years. Ms. Whitcomb was first prescribed a CGM by a nurse practitioner, and she used it successfully during a six-month trial. In 2011, she sought to have the device covered under her UnitedHealthcare Securehorizons Medicare plan. The Medicare-insuring contractor denied the claim. She appealed through the complex Medicare appeal process. Two years later, when she’d reached the administrative law judge (ALJ) level of appeal, a judge determined that even though a CGM didn’t fit into Medicare’s definition of “glucose monitor,” the benefit was indeed available under her plan. UnitedHealthcare appealed to the Medicare Appeals Council, which reversed the decision by arguing that a CGM is a “precautionary” rather than “medically necessary” device. Ms. Whitcomb took her appeal a step further to the federal district court for eastern Wisconsin. In May 2015, a federal judge ruled that the Medicare Appeals Council decision was in error and sent the case back to the council. That’s where the case now stands. Debra Parrish, a former DHHS staff attorney who now represents Ms. Whitcomb, successfully pushed back against UnitedHealthcare’s outdated understanding of what a CGM does. She also was able to Continue reading >>
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Medicare Coverage Of Blood Sugar Monitors
What It Is Blood sugar (glucose) monitors, blood sugar test strips, lancets and lancet devices, and glucose control solutions, used for monitoring blood sugar levels in patients with diabetes What's Covered Medicare Part B covers all of the above supplies used to monitor blood sugar levels in patients with diabetes, as long as the supplies are prescribed by a physician and provided by a doctor or medical supply company that participates in Medicare. If you have a Medicare Part C Medicare Advantage plan: Medicare Part C Medicare Advantage plans, also called Medicare Advantage plans, must cover everything that's included in original Medicare Part A and Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. (Co-payments for Part C plans may also be different than those for Part A or Part B.) To find out whether your plan provides extra coverage or requires different co-payments for blood sugar monitors, contact the plan directly. What Medicare Pays Medicare Part B pays 80 percent of the Medicare-approved amount for these covered medical supplies. Warning: Make sure you buy your supplies from what's called a Medicare "participating supplier." These suppliers can't charge more than the Medicare-approved amount for supplies, leaving you to pay no more than the 20 percent of the approved amount that Medicare doesn't pay. However, if you buy from a supplier who is enrolled in Medicare but isn't an officially "participating supplier," that supplier can charge more than the Medicare-approved amount for the supplies. In that case, you must personally pay the difference between the Medicare-approved amount and the amount the supplier actually charges, plus the 20 percent of the Medicare-approved amount that Medicare doesn't Continue reading >>
Medicare Coverage Of Glucose Monitors
| Licensed since 2007 Print What are glucose monitors used for? If you have been diagnosed with diabetes, a glucose monitor can help you manage your disease and prevent complications, according to the National Institutes of Health (NIH). A glucose monitor measures your blood sugar (glucose) levels so you can make informed decisions about eating, exercising, and taking prescription medications, such as insulin. According to the NIH, one way to monitor your glucose levels is by using a finger-stick device to collect a drop of blood, which you put into a glucose monitor on a set schedule each day. An alternative site glucose monitor allows blood samples from areas such as your palm or thigh, according to the Mayo Clinic. As well as a glucose monitor, you may also need other testing supplies, such as lancets, glucose test strips, and a glucose control solution. Medicare coverage of glucose monitors Under Original Medicare (Part A and Part B), Part A covers health-care expenses you incur as an inpatient in a hospital, while Part B covers your outpatient care, including some glucose monitoring supplies and durable medical equipment. Medicare does not generally cover “continuous glucose monitoring,” which (according to the NIH) involves a sensor inserted under your skin for several days to a week. If your health-care provider recommends a different way to monitor your blood sugar other than the finger-stick glucose monitor, you might want to check with Medicare to see whether it’s covered. You can reach a Medicare representative 24 hours a day, seven days a week, if you call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. If you have a Medicare Advantage plan, call your plan to ask about this coverage. How does Medicare treat durable medical equipment Continue reading >>
Alleviating The Confusion Over New Changes Around Diabetes Supplies
The Medicare rules for ordering diabetes supplies through a mail-order pharmacy have changed. Here is the information you need to know to make this transition smoothly. On July 1, a Medicare rule took effect that impacts beneficiaries who get their diabetes testing supplies via mail order. It’s referred to as the Medicare National Mail-Order Program. Under the new ruling, beneficiaries must buy their diabetes supplies, including blood glucose trips, lancets, lancet devices, batteries and control solution, through a list of designated vendors, or Medicare national mail-order contract suppliers. Beneficiaries who pick up their testing supplies from a local pharmacy can still do so, but they need to make sure that the store accepts Medicare "assignment" to avoid higher charges for the supplies. At Joslin Diabetes Center, we are closely monitoring this new program which is intended to be a cost-cutting measure. If you have questions or difficulties navigating the new system, we provided you with additional details to ensure the program is not a disruption to your diabetes care. Who is affected? Medicare beneficiaries in all 50 states, D.C., Puerto Rico, the U.S. Virgin Islands, Guam, and American Samoa, who have Original Medicare, are impacted. These changes do not apply to Medicare Advantage plans (like an HMO or PPO). If you are enrolled in a private plan through Medicare, you can contact your plan to find out which suppliers you can use. How can I get my supplies? If you want diabetes testing supplies delivered to your home, you must use an approved Medicare national mail-order contract supplier in order for Medicare to help pay for the supplies. To find a contract supplier, you can call 1-800-MEDICARE (1-800-633-4227) or visit www.medicare.gov/supplier. Alternatively, Continue reading >>