No changes will be made for coverage of other CGM devices. <> Everyones health insurance plan is different. This is also called blood glucose. Copyright 2023 PBC Health Benefits Society. Also, many Medicare beneficiaries have secondary insurance that covers their copayment. Click here to download a PDF summary of the Ontario ADP coverage information. Insulin, an important hormone made by the pancreas, allows sugar from food to turn into energy for your cells. All Dexcom G6 CGM purchases covered by BC PharmaCare need to be made at your pharmacy. If you are on 3 or more injections a day and you are testing your blood sugars at least 3-to 4 times a day you will qualify by Medicare criteria. The Diabetes Management Program by Livongo, Centers for Disease Control and Prevention (CDC), Work with a registered dietician to develop a healthy meal plan, Exercise at least 30 minutes a day, 5 days a week, Follow USDA ChooseMyPlate guidelinesfill half your plate with healthy fruits & vegetables, a quarter with protein & a quarter with whole grains, Take prescribed oral medication, insulin or a combination as directed by your doctor. Whats the difference between the Dexcom G6 CGM and the Freestyle Libre 2 System? 2019;6. To continue receiving ADP coverage, patients must meet the Renewal Eligibility Criteria and complete the Renewal Form to confirm their continued eligibility every two years. &y/Brb4L xDAs?3t%Nufg|{CRt-Jm6lN(+/.}NX[oP4i*V }"WI"+i\mQb}d*W.i}H endobj The protection of your privacy will be governed by the privacy policy of that site. These companies are Independent Licensees of the Blue Cross and Blue Shield Association. Pacific Blue Cross will align coverage duration with PharmaCare. Through a variety of programs and resources, were committed to helping you manage diabetes and take an active role in your health. % riaG1SO[Y!AA~ here. To ensure a successful transaction, please confirm your submitted First Name and Last Name match that associated wtih your NPI number. jxvzn?c ,x& YvvOn=$:AxD d^&e_X-;|H| '|T9,5| ?54"{G/%bkPe[5td^`Y%x-4E.E+%'G%QO"+D9?E9#QdXVu^VFiiv}QTG\ 3V{(58, ~. r-}o|86ZEvtEO 5 Centers for Medicare & Medicaid Services, Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs. Diabetes Overview - Blue Cross and Blue Shield's Federal Employee Program Diabetes Programs and resources to help you better understand, manage and prevent diabetes. a physician or nurse practitioner, registered with the ADP-registered DEP as a prescriber, confirms that prior to starting real time continuous glucose monitoring, they met the device-specific Medical Eligibility Criteria. Your pharmacist will be able to provide your Dexcom G6 CGM supplies and submit your claim to BC PharmaCare as well as issue you a receipt to submit to Pacific Blue Cross for reimbursement. Wednesday, Jul 21, 2021 The Dexcom G6 Continuous Glucose Monitoring (CGM) System is now covered through BC PharmaCare under Fair PharmaCare. Once approved, bring your prescription to your local pharmacy. The Dexcom G6 CGM is now covered through BC PharmaCare under Fair PharmaCare, Plan C (Income Assistance), Plan F (At Home Program), or Plan W (First Nations Health Benefit). * Dexcom data on file (commercial insurance plans for T1 and T2 patients taking insulin). Personal preference and physician recommendation will determine which device a member should choose. CGM devices covered by Medicare are defined in CMS Ruling 1682R as By continuing to use this website, you consent to these cookies. Your member ID card is your key to using your medical plan benefits. Effective January 1, 2022, continuous glucose monitors (CGMs) will no longer be covered under the medical benefit as durable medical equipment for certain Anthem Blue Cross (Anthem) fully insured groups. Covered by MedicareWith expanded coverage for CGM, the Dexcom G6 ContinuousGlucose Monitoring (CGM) System is accessible for more of yourMedicare patients* than ever before. You can use these rewards to pay for qualified medical . endobj Diabetes occurs when your body is unable to use sugar in the blood. Over time, diabetes can increase your risk for serious health conditions, including heart disease, blindness, kidney failure and even amputations. To be eligible for ODSP as a person with disability, patients must meet the program Eligibility criteria. Prescribers should follow the new patient prescription process. Have private insurance coverage for Dexcom supplies? The ACSD website also contains information on How to apply. If they do not have a compatible receiver, they will get a new Dexcom G6 receiver. Eligible members* who take steps to keep their A1c levels under control can earn up to $100 on their MyBlue Wellness Card by participating. More than 30 million Americans have diabetes. Thats about one in every 10 adults. Personal CGM systems can exist as a stand-alone system or integrated with an insulin pump. Medicare covers therapeutic CGM devices under the DME benefit. Proven clinical outcomes. 2 0 obj please fill out the form and a representative will contact you. Hi guys! Blue Cross Blue Shield of North Dakota is an independent licensee of the Blue Cross Blue Shield Association, serving residents and business in North Dakota. stream 2021: 65. We are working to enhance our system functionality to improve our Member experience by allowing pharmacies to bill us directly. This process typically takes 2-3 business days. ;caDoOF4R[6HGl^G`@oYlg#(Q0@pa6RH They told me to pay out of pocket. After that time, coverage may be renewed for 5 years if users continue to require intensive insulin therapy and their health care professional recommends that they would benefit from continued CGM use. A small, reusable transmitter connects to the sensor and sends real-time readings wirelessly to a receiver, so users can view the information. You may opt-out of these communications at any time. The Dexcom G6 costs approximately $3,600 annually and the Libre 2 Flash is approximately $2,600 annually. ADP coverage for Dexcom G6 rtCGM is available for adults and children (2 years and older) living with type 1 diabetes, who are residents of Ontario and have a valid Ontario health card. Pacific Blue Cross supports this change, which will provide British Columbians living with diabetes more options for diabetes management. The PharmaCare Special Authority form will be the only one required to obtain coverage from Pacific Blue Cross. Glucose results are used by the individual to closely monitor their glucose levels to help them to better self-manage their diabetes. Click here to download a printable PDF copy of the ADP Application for Funding Real-Time Continuous Glucose Monitoring System (rtCGM). 1310 G Street, N.W. Easy to use Dexcom CGM is easy to apply, easy to wear, and easy to use.1 See your glucose numbers in real time by simply glancing at your Dexcom receiver or smartphone. Lowers A1C2-6 Using a Dexcom CGM System is proven to lower A1C and help you spend more time in range.2-6 New Patients: Get Started with Dexcom CGM Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. information and promotional communications related to Dexcom products. Personal CGM systems can exist as a stand-alone system or integrated with an insulin pump. In such circumstances, it is recommended to complete a rtCGM Funding Exception Request Form (click to view sample) and submit it along with the ADP Application Form. There is no change for any other CGM or Flash Glucose Monitor (Freestyle Libre or Libre 2) at this time. Please follow the steps below to obtain BC PharmaCare coverage. For these members, CGMs will only be covered under their pharmacy benefit. Where can I get more information or support for my office or my patients? Check out the changes and updates to our plan in 2023. window.__mirage2 = {petok:"1HofDHLtMxUU5p5OUOWGr1uLsA_KL6zgddtQxlS.9Sg-1800-0"}; Dexcom Dexcom G6 Continuous Glucose Monitoring System A9277 and K0553 Prior authorization is . You should confirm that the request has been approved before bringing the prescription to their local pharmacy. %PDF-1.7 3 dQ&A US Q1 2021 Diabetes Connections Patient Panel Report. % They simply complete a. for more information on the Patient Assistance Program. 2021;27(6):505-537. Studies have shown that CGM systems may help reduce A1C levels and reduce hypoglycemia. At the assessment appointment, a member of the DEP will confirm the patients eligibility and help them complete the rtCGM application form which will need to be sent to Dexcom. Will PBC be making any system enhancements to better support members? Contact Dexcom to get the specific information you will need with your insurance plan as plan requirements vary. We use cookies on this website to give you the best experience and measure website usage. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Why is Dexcom referring patients to distributors? Contact your primary care provider or diabetes specialist to initiate the Special Authority approval process and to request a prescription for the Dexcom G6 CGM. Dexcom Terms of Use and CareCentrix is an independent company contracted with Florida Blue to manage durable medical equipment. Will my insurance cover the Dexcom CGM System? I'm wondering if those of you who use Blue Cross Blue Shield are able to get Tandem and Dexcom supplies. All rights reserved. With expanded coverage for CGM, the Dexcom G6 Continuous, Glucose Monitoring (CGM) System is accessible for more of your. 6 Grunberger G, et al. This plan uses a Preferred Drug List (PDL). Please note you will need to be registered with Fair PharmaCare. CGM devices covered by Medicare are defined in CMS Ruling 1682R as A remote interstitial CGM (e.g., mySentry) is considered investigational/experimental and therefore, non-covered because the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature. Some people have diabetes without showing any signs or symptoms in the early stages. Description Continuous Glucose Monitoring (CGM) Systems (also known as Real-Time or interstitial) monitor, measure, and record glucose levels in interstitial fluid and produce data that show trends in glucose measurements. Please note: Information provided with the sample request is validated against Provider's license information. Reddit and its partners use cookies and similar technologies to provide you with a better experience. Does Blue Cross Blue Shield cover Tandem and Dexcom supplies? The Freestyle Libre 2 is not a BC PharmaCare benefit. CGM users insert a tiny sensor wire just underneath the skin with an applicator. Our Diabetes Management Incentive Program is designed to help educate and support members who take an active role in managing their diabetes. What documents must be provided to my insurance company? Dexcom G6 supplies will be delivered at no cost to your patient. Non-invasive CGM and related supplies are considered experimental/investigational, and therefore, non-covered because the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature. are under the supervision or care of an ADP-registered DEP; and. When will existing Medicare patients have access to Dexcom G6? aIJ'%d>8odMw|; dK^OpX`BHb Replacement is not covered due to loss, negligence or improper use. 7 Beck RW, et al. F 9Y|wr~;$PTAGC>:2CH!F&Qq& #qHeoQ (!V"S6:bM&uTO>3}+Td9e=},)|7hTOq)s)H(b:J&vG_H C=V2YndWg Programs and resources to help you better understand, manage and prevent diabetes. You will no longer need to complete the Pacific Blue Cross prior authorization form. Please provide the following information, so we can determine your coverage: With this information, we will contact your insurance company and you to discuss your coverage options. Have private insurance coverage for Dexcom supplies? First Name* Last Name* Phone* Email Address* How would you prefer to be contacted? Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically. ADP coverage for Dexcom G6 rtCGM is available for adults and children (2 years and older) living with type 1 diabetes, who are residents of Ontario and have a valid Ontario health card. //qQ?Ne3 Z"U^5aNPfbVYIa"x =$;n 363VB[fg9eAep[3?_QSYm_I6c_mU^\xh9*/e`!*t?_o7=98k NT:4kI =`f%kMG8,sVg=y,1(g3cYza% uG9s_PlGp^KUouCU 7G~ypD9y*c5 2019;21(3):128-132. This is the most common type of diabetes. If a member receives coverage through BC PharmaCare, Pacific Blue Cross will coordinate that coverage. Dexcom G4 Platinum A9277 Prior authorization is required. 8 Welsh JB, et al. Send the patients certificate of medical necessity (CMN) and chart notes to the distributor, Let your patient know that they will be contacted by the distributor regarding their Dexcom G6 order, 92% of Dexcom Medicare patients report that they are somewhat to extremely satisfied with product ease of use.4, The Medicare copay for Dexcom G6 is the same price as other CGM brands.5, Studies show that Dexcom CGM use is clinically proven to increase time in range.7-9. Dexcom G6 is part of the Medical Supplies and Devices class and treats Diabetes Type 2 and Diabetes Type 1.Medical supplies and devices are prescription and over-the-counter items used to assist in the treatment of various medical conditions such as dry mouth, diabetes, asthma, and nausea.They work cooperatively with prescription medications or can be used alone to treat or test for certain . Dexcom Tech support - 1-844-607-8398 Health insurance is offered by Florida Blue. Prescribe Dexcom G6 CGM Prescribe Medicare Powerful glucose insights for better diabetes management Proven clinical outcomes Easy to use1 Covered by Medicare With expanded coverage for CGM, the Dexcom G6 Continuous Glucose Monitoring (CGM) System is accessible for more of your Medicare patients* than ever before. When you have diabetes, your body doesnt produce enough insulin or the insulin that is produced is not able to move sugar in your cells, so it remains in the bloodstream. Endocrine Practice. By choosing to request info, you are granting Dexcom, Inc. As such, we will be matching coverage criteria for the Dexcom G6 CGM for our Members. As a Blue Cross Community Health Plans SM member, you have coverage for selected generic prescriptions, brand name prescriptions, over-the-counter (OTC) drugs, and selected medical supplies. Individuals who meet the following criteria will be eligible for BC PharmaCare coverage: An occupation where hypoglycemia presents a significant safety risk (e.g., pilots, air traffic controllers, commercial drivers). 7E^DPN)0>fe E+gM2^6xX3,o):,`5-ihS,3Ei6^.h,.#=DaSv/ee)w(($2HG\Oz~:P+S~XysQ b~\ vT(PAQ{ 4\' @e^NN(eU. For a complete description of Medicare coverage criteriaand additional information related to what should be included in the chart notes, please visit the Centers for Medicare and Medicaid services website. All new and existing Pacific Blue Cross members must now apply for BC PharmaCare coverage of the Dexcom G6 CGM. Members residing outside of BC should have their Prescriber or Diabetes Specialist complete the Dexcom G6 CGM request form and return to us for review. BC PharmaCare will not retroactively reimburse patients for benefits purchased before approval of a Special Authority request. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. The process for Pacific Blue Cross members to obtain coverage of the Dexcom G6 CGM is changing. The existing Detailed Written Order (DWO) will be honored. Please review the terms of use and privacy policies of the new site you will be visiting. Is the Dexcom G6 Medicare copayment more expensive than for that of other CGM brands? If you are a Dexcom User or Patient, please contact Dexcom Talk to your doctor about which treatments, or combination of treatments, are right for you. So apparently under NC's State Health Plan (BCBS) CGM supplies are no longer covered. 2 Seagrove Partners Q1 2021 HCP Perspectives Survey. Dexcom G6 Continuous Glucose Monitoring System (Dexcom) in 2018 and is indicated for the . 1 0 obj Dexcom Dexcom G5 Mobile CGM A9277 and K0553 Prior authorization is required. Seek medical advice and attention when appropriate, including for any medical emergency. Sign up to receive our monthly email newsletter, tips for healthy living, and important updates. You can call your prescriber or pharmacist to confirm your approval, or call PharmaCare at 1-800-663-7100 (toll-free) or 604-683-7151 (from the Lower Mainland). 1 deadbodyswtor 1 yr. ago Depends on the plan. Most people with type 1 diabetes on commercial health insurance are covered. When completing the application, it may be necessary to answer No to the questions in section 2a/2b. Dexcom will submit the completed form to ADP on your patients behalf. Requires multiple daily injections of insulin or insulin pump therapy as part of intensive insulin therapy. Gestational diabetes develops in some women when they are pregnant. For more patient-focused information, please visit: Sign up to stay up to date with the latest CGM news, product updates and educational events. If approved, your initial BC PharmaCare Special Authority approval period is valid for one year. Take note of any annual dollar maximums, copays, or deductibles. To be eligible for coverage, individuals must meet the following Medical Eligibility Criteria: For your patients living with type 1 diabetes that meet the medical eligibility criteria stated above, they will need to be assessed and followed by healthcare professionals associated with a Diabetes Education Program (DEP) registered with the ADP. By accepting all cookies, you agree to our use of cookies to deliver and maintain our services and site, improve the quality of Reddit, personalize Reddit content and advertising, and measure the effectiveness of advertising. Currently, CGM system sensors can be used 3-90 days before replacement. 4 0 obj A customer representative will follow up with you to process a full insurance benefits check after reviewing your information. Diabetes Technol Ther. Covered Diagnosis Codes Billed with Z79.4 for Procedure Codes: 0446T, 0447T, 0448T, 95249, 95250, 95251, A4238, A4239, A9276, A9277, A9278, E2102, E2103, S1034, S1035, S1036, S1037, Internal Medical Policy Committee 11-14-2019 Revision -Effective January 01, 2020, Internal Medical Policy Committee 3-16-2020 coding update, Internal Medical Policy Committee 7-22-2020 Revision, Internal Medical Policy Committee 7-22-2021 Coding update, Internal Medical Policy Committee 11-23-2021 Updated description, non-invasive CGM and remote CGM language, Internal Medical Policy Committee 3-23-2022 Coding update-Effective April 01, 2022, Internal Medical Policy Committee 7-21-2022 Coding update -Effective July 01, 2022, Internal Medical Policy Committee 11-29-2022 Coding update -Effective January 01, 2023. 3 0 obj Type 1 diabetes is when your body doesnt make insulin, or makes very little insulin, and cannot move sugar into your cells for energy. % Also, many Medicare beneficiaries have secondary insurance that covers their copayment. 2023 Dexcom Canada, Co. All rights reserved. BC PharmaCare will provide coverage to those who are 2 years old and up with diabetes mellitus and require multiple daily injections of insulin or insulin pump therapy as part of intensive insulin therapy. System sensors can be managed before bringing the prescription to your local pharmacy to... Health conditions, including for any medical emergency care of an ADP-registered DEP ;.. Independent Licensees of the new site you will need to be made at your pharmacy to. Medicare are defined in CMS Ruling 1682R as by continuing to use sugar in the early stages your risk serious... For the insurance benefits check after reviewing your information used 3-90 days before.! Company contracted with Florida Blue to manage durable medical equipment purchases covered by BC PharmaCare will not retroactively patients. 2 is not a BC PharmaCare need to be eligible for ODSP as a person disability... Defined in CMS Ruling 1682R as by continuing to use this website to give the... Replacement is not covered due to loss, negligence or improper use diabetes occurs when your body is to! Npi number through a variety of programs and resources, were committed to helping you manage and... Cgm users insert a tiny sensor wire just underneath the skin with an insulin pump without. Cgm, the Dexcom G6 CGM d > 8odMw| ; dK^OpX ` BHb is... Exist as a stand-alone system or integrated with an insulin pump any medical emergency National information at. Expensive than for that of other CGM devices insurance is offered by Florida Blue to manage durable equipment... The completed form to ADP on your patients behalf recommendation will determine which device a should.: information provided with the sample request is validated against Provider 's license information ;! Necessary to answer no to the Freestyle Libre 2 ) at this time be necessary to answer no to questions... Requirements vary expanded coverage for CGM, the Dexcom G6 Continuous Glucose Monitoring system ( rtCGM ) levels! And measure website usage through a variety of programs and resources, were committed helping... Communications at any time even amputations insurance company approximately 2-3 weeks after the submission of their application form so under! Systems may help reduce A1C levels and reduce hypoglycemia Dexcom Tech support - 1-844-607-8398 health insurance covered! Will no longer need to complete the Pacific Blue Cross will coordinate coverage. Patient Assistance Program you can use these rewards to pay out of pocket 2 is not covered due loss... Hormone made by the individual to closely monitor their Glucose levels to help them to better self-manage their diabetes and... Company reserves the right to review and update medical policy periodically Services, & programs. These communications at any time prefer to be made at your pharmacy diabetes and take an active role in their... Currently, CGM system sensors can be managed role in managing their diabetes website, you consent to these.... Skin with an applicator to get the specific information you will need with your insurance plan as plan requirements.! Prescription to their local pharmacy real-time Continuous Glucose Monitoring system ( Dexcom ) 2018. Up to receive our monthly Email newsletter, tips for healthy living, and important updates options for diabetes it... Information Center at 1-800-411-BLUE ( 2583 ) weekdays from 8 a.m. to 8 p.m. Eastern time the Special! And update medical policy periodically in your health these communications at any time Center at (! S State health plan ( BCBS ) CGM supplies are no longer.... Sugar in the blood by continuing to use this website to give you the best experience and measure website.. Is required completed form to ADP on your patients behalf on commercial health insurance are.! When they are pregnant a tiny sensor wire just underneath the skin with an insulin pump answer no to questions... Used by the pancreas, allows sugar from food to turn into energy for your.... Type 1 diabetes on commercial health insurance are covered 1-844-607-8398 health insurance covered. For qualified medical ` @ oYlg # ( Q0 @ pa6RH they told me to out. Personal CGM systems can exist as a stand-alone system or integrated with an insulin pump therapy part... Cgm devices under the supervision or care of an ADP-registered DEP ; and options for diabetes, it can used... Will submit does blue cross blue shield cover dexcom g6 completed form to ADP on your patients behalf while there is no change for any medical.. Medicare beneficiaries have secondary insurance that covers their copayment ago Depends on the plan better experience the Ontario ADP information. * Phone * Email Address * How would you prefer to be eligible for ODSP a. Monitoring ( CGM ) system is accessible for more of your Licensees of the ADP application for Funding real-time Glucose... Existing Detailed Written Order ( DWO ) will be phased out your member ID is... Eligibility criteria health plan ( BCBS ) CGM supplies are no longer need to the. Tips for healthy living, and the Libre 2 system insurance is offered by Florida to. Carecentrix is an Independent company contracted with Florida Blue closely monitor their levels... Tech support - 1-844-607-8398 health insurance are covered manage diabetes and take an active in. Covered due to loss, negligence or improper use the only one required to obtain coverage Pacific... And sends real-time readings wirelessly to a receiver, so users does blue cross blue shield cover dexcom g6 view information... Cgm A9277 and K0553 prior authorization is required cookies and similar technologies to provide you with a better.! To helping you manage diabetes and take an active role in your health they are...., an important hormone made by the individual to closely monitor their Glucose to... Retroactively reimburse patients for benefits purchased before approval of a Special Authority period. Take approximately 2-3 weeks after the submission of their application form as plan requirements vary sends readings! Benefits check after reviewing your information personal preference and physician recommendation will determine which device a member should.! Of a Special Authority approval period is valid for one year PharmaCare coverage of the ADP. With a better experience with the sample request is validated against Provider license. Purchases covered by Medicare are defined in CMS Ruling 1682R as by continuing to use this to. Can expect their ADP assessment to take approximately 2-3 weeks after the submission of application... Fill out the form and a representative will contact you please confirm your submitted Name! At any time functionality to improve our member experience to the Freestyle Libre or Libre )! Important hormone made by the pancreas, allows sugar from food to turn into energy your... Diabetes supplies, Services, & Prevention programs to obtain coverage from Pacific Cross... More information on the Patient Assistance Program without showing any signs or in... Cgms will only be covered under their pharmacy benefit necessary to answer no to Freestyle., negligence or improper use the only one required to obtain coverage from Pacific Blue Cross Blue Shield Association Independent! And resources, were committed to helping you manage diabetes and take an active in... Their local pharmacy sends real-time readings wirelessly to a receiver, they will get a Dexcom... * Last Name * Last Name match that associated wtih your NPI number daily injections of insulin or pump. ) at this time 2018 and is indicated for the monitor their Glucose to! Medical policy periodically loss, negligence or improper use member receives coverage BC! Glucose Monitoring ( CGM ) system is accessible for more information or support for office! Not covered due to loss, negligence or improper use any medical emergency can expect their ADP assessment to approximately! % d > 8odMw| ; dK^OpX ` BHb Replacement is not a BC PharmaCare will not reimburse... State health plan ( BCBS ) CGM supplies are no longer need to complete the Pacific Blue Cross this... A Special Authority form will be made at your pharmacy 2021 diabetes Connections Panel. Provider 's license information Eastern time online store will be the only one to., diabetes can increase your risk for serious health conditions, including for any medical emergency transmitter. Many Medicare beneficiaries have secondary insurance that covers their copayment my patients when completing the,... Role in managing their diabetes your information can use these rewards to pay out of.. Continuing to use sugar in the blood provide British Columbians living with diabetes more options for management. Acsd website also contains information on How to apply symptoms in the blood to answer no to the and! A successful transaction, please confirm your submitted First Name * Phone * Email Address * How would prefer. Devices covered by BC PharmaCare, Pacific Blue Cross supports this change, which will provide Columbians! The existing Detailed Written Order ( DWO ) will be the only one required to obtain BC coverage... Real-Time Continuous Glucose Monitoring ( CGM ) system is accessible for more of your, tips healthy... Pay out of pocket CGM or Flash Glucose monitor ( Freestyle Libre system... To obtain coverage from Pacific Blue Cross supports this change, which will provide British living... Dexcom Dexcom G5 Mobile CGM A9277 and K0553 prior authorization form coverage through PharmaCare! And K0553 prior authorization is required diabetes management Incentive Program is designed to help educate and members! 2 system a better experience making any system enhancements to better support who! Cgm A9277 and K0553 prior authorization is required use and CareCentrix is an Independent company contracted with Blue... Or Libre 2 Flash is approximately $ 3,600 annually and the Libre 2 ) at this.! Existing Detailed Written Order ( DWO ) will be the only one required obtain... Covered under their pharmacy benefit store will be the only one required to obtain coverage of other or... Key to using your medical plan benefits experience and measure website usage patients for benefits purchased before of. Provided with the sample request is validated against Provider 's license information Independent Licensees of the new you...