I’ve recently switched from Byram Health to CVS for my Dexcom 6. I have a prescription for a 3 month supply but CVS has been having an issue with it and Medicare won’t let them bill for more than a one month supply. Has anybody else run into this?
I’m doing my own reply here
I just got a call back from CVS and they said that when they bill Medicare it goes thru another supplier first which stops them from giving a 3 month supply of the sensors.
Interesting, Anne @Anne98.
Is the “another supplier” your Medicare Advantage insurer or is CVS trying to bill Medicare directly? Recently, just after I had received my 90 G6 supply from Byram, the Walgreens pharmacist told me that he can now fill my G7 prescription - he didn’t mention that there is a 30 day max order. I’ll need to clarify this before I change from Byram.
Thanks for the heads-up.
CVS was trying to bill Medicare directly.
After more investigation, CVS does not have a direst contract with Medicare for live billing so it goes thru a 3rd party billing thru a company called Omnisys.
Omnisys contract with CVS is that CVS can only fill Dexcom as 30 day supply even though Medicare recognizes the 90 day supply as does CVS.
I got this from the pharmacist at my CVS and she was unaware of this. They could not figure out why they could not bill for a 90 day supply so they did the investigation for me.
I’d be curious as to what other pharmacies have these issues.
This is an interesting topic for me. I’m a couple years away from Medicare and I’m starting to do some research into CGMs. I asked CVS today if they are able to bill Medicare Part B for Dexcom G6/G7 and they told me it was 50/50 which really didn’t answer my question at all. I’m going to ask at Walgreens pretty soon as I’ve heard they can bill Part B. Will have to ask about the 30 vs 90 day supply.
I hope I stated issue and results correctly. But the bottom line is there is a 3rd party contracted by Medicare stopping some pharmacies from being able to fulfill a 3 month supply of Dexcom sensors.
@St4386119 Welcome Lori to the JDRF TypeOneNation Community Forum.
It is wise to be looking ahead so that you will have a good idea how to get needed supplies when you venture into Medicare.
I suggest the when you switch to Medicare that you contact Dexcom customer service, or any Dexcom Rep that you have met, and ask that rep to assist in setting up proper billing. For instance, the Dexcom rep I asked to assist me told me that in Florida that Dexcom could not directly bill Medicare [???], so she contacted Byram [ mybyramhealthcare,com ] and set up an account for me. Later when I began using Tandem, the Tandem rep sent my pump order through Byram; both the Tandem and Dexcom supplies are refilled by responding to a text message with a “#1” response - always 90 day supplies.
Hi @Anne98. CVS choose to use Omnisys so It is CVS’s responsibility to fix their Omnisys implementation. Here is a list of Durable Medical Equipment supply companies that sell Dexcom that I’ve made. If you find out which ones will bill Medicare Part B let me know, I’ll add a column and info then maybe @Dennis will make it into a wiki topic.
|Advanced Diabetes Supply
|Better Living Now Inc. (Rotech)
|Diabetes Supply Center of the Midlands (Adapthealth)
|Healthy Living Medical Supplies
|Heart Medical Equipment
|Pinnacle Medical Solutions (Adapthealth)
|90074, 38125, 35630, 38672
|US Med (ADS)
Thank you for the list. I will probably stick out CVS for a bit as it is less than a mile from my house. But 1 month at a time takes up a bit more time and planning. The prescription also cannot be put on redi-fill and won’t allow CVS to process until the 30 day mark.
The reason I switched from Byram as I seemed to be always the go between them and my doctor and a live person at Byram seemed to not exist…Fed-Ex delivery was ransom at best and I never knew where I would find the box. In the shrubs, in a puddle or even at a neighbors. Fed-Ex was not much help either.
Could you have the packages delivered to your workplace? It may not be as private as you would like but I imagine company mailrooms are busy and the clerks are not paying close attention unless the package comes from Fredericks of Hollywood😊.
That could be a solution except I’m retired. My husband and I like to travel so having the convenience of the local pharmacy for my supplies seemed like a good option for me. Interestingly, I get my 3 month Omni Pod 5 supplies from CVS and the transmitter for the Dexcom gets filled automatically. There is definitely a disconnect for the sensors themselves.
Not one to take no for an answer, I’m going to see what else I can find out about this.
Oops (head slap)! A couple of things you could do:
First - I imagine you’ve already complained to Fedex about about the issues with delivery of your packages. Let your supplier know as well. There may be an issue with a specific Fedex branch that needs to be addressed but in any case they have a contract with Fedex and complaints add up - you may not be the only person with an issue and they need to handle it or risk their business going to another company. Your call may be a small drop in a big bucket but those do accumulate over time; and at the very least you will have done your part to try to solve the problem.
Second - I was hoping Fedex had pickup lockers like Amazon does, but I wasn’t able to find anything about that. However, once you have the tracking number you can track your parcel and request that Fedex redirect it to one of their locations for you to pick up yourself: their website provides a list of dropoff locations to choose from.
And last - you can also have your package delivered directly to a retail network location where you can pick it up. You may need to make arrangements for someone to get it for you.
CVS sucks with Medicare. Even Medtronic does 3 months of sensors now with Medicare.
I use CCS for my CGM supplies and they told me a few months ago that they can only send me one month of CGM supplies at a time now because Medicare requires them to bill on a monthly basis. Previously, I was using ADS for my CGM sensors and transmitters, and we had a lot of confusion with them shipping me a 3-month supply and having to bill Medicare every month for those supplies. I don’t know if ADS has changed how they are doing things now because I no longer use them. Medicare is a beast (and often more like a dinosaur) to contend with! Our health care system is in seriously bad shape!
Just spoke with my dad who lives in south Florida and has Dexcom G6. He told me Medcare is the company that works with Medicare and ships the sensors to him, but has always been one box of 3 sensors per month. Never 90 days.
Edith @eroig13, I live in south Florida, on the Gulf and have always used Byram [ byramhealthcare.com ] to fill my Medicare paid Dexcom prescriptions - G5, G6, and now and future G7 - and for the past 6 years have always received a 90-day supply.
When I began using Dexcom, I asked the Dexcom agent to set up my account. Since I began using a phone with text messaging, my re-order every three months has become very simple - when reorder time approaches Byram sends me a text asking if I want the same as last refill to which I need only respond to the text with a very simple “1”. Byram also handles my Tandem pump supplies the same way, including a new pump which I’m now using.
I’m not on Medicare yet but I’ve done a lot of learning about CGM coverage.
Medicare will cover a 90-day supply of all things required for blood glucose testing including CGMs
Easy to read but non-specific Medicare published document on diabetes supplies
Hard to read but very specific Medicare published rules on Glucose Monitors
There are many things that can go wrong with processing your CGM order that may affect you getting 30 days of sensors instead of 90. One is the doctor, or the person the doctor is delegating to handle CGM prescriptions is accidently writing a script with 30 day refills instead of 90. Ask your doc next time you see them to double check. My doc or her office makes this mistake at least twice a year.
Another possibility is CCS is forcing you to accept 30 day supplies because then they can charge Medicare more dispensing fees. Next time you order specify a 90 day supply. If they resist again try
- Reference CMS article A52464 that says you can get a 90 day supply
- Ask to speak with a Medicare Billing specialist
- Call Medicare and ask them to call CCS with you
Note that if you are on a medicare advantage plan most of this might not apply.
Thanks for the links and info! I’ll read through these documents.
I found this, which is helpful to me, as well. I will make sure I can start getting a 90-day supply of CGM supplies from now on. https://www.homecaremag.com/news/cms-allow-90-day-billing-cgm-supplies
Thanks, do they take Medicare insurance plans? From what I read they bill the patient and my father has Medicare pay for his supplies until he reaches his limit. I will call the customer service number next week to find out if they work with my dad’s plan.