Dexcom on Medicare

This is a copy of a message I sent to my congressman. Can anyone relate? Is there another answer?

I am a type 1 Diabetic on Medicare. As a diabetic I have to deal with my condition and the complications on a daily basis. If you know anyone with my condition, they will tell you that it is a life long disease which can never be beaten, only endured. The best I can hope for on a daily basis is to constantly monitor my situation and continually react.
What I don’t need is to be constantly fighting with Medicare and their rules which make my life even more difficult.
I am on an insulin pump which Medicare pays for, and for that I am thankful. This technology is very beneficial but it requires supplies which have to be ordered regularly. The pump and supplies are all classified as durable medical supplies and as such are covered under Part B Medicare. The supplies fall into three general categories: pump supplies, continuous glucose monitoring supplies, and insulin. You can order a 90-day supply of pump supplies and insulin.
The problem is with the glucose monitoring supplies. These can only be ordered as a 30-day supply and the process is so cumbersome, that because they are shipped from a Medicare approved vendor, they do not always arrive on time which means the entire system is compromised. The only possible reason I can imagine for this rule is that Medicare believes I might not be a diabetic 30 days from now.
The time it takes to drive orders, monitor order progress, and confirm supplies have shipped is overwhelming. In addition, because the shipping a delivery process can take up to 2 weeks, it requires that I stay close to home to accept the delivery never sure when exactly they will arrive.
This whole policy is cumbersome and unnecessary. No one can explain to me why this policy is in place and what logical sense it makes. It seems to me that this is some arbitrary bureaucratic decision which should be changed.
It would eliminate so much stress and inconvenience – neither of which I need as a diabetic – if the policy would simply allow me, and I suppose many others like me, to order all supplies in 90 day increments.
I am a diabetic, I will still be a diabetic 30 days, 90 days, a year from now. My supply needs will not change. I hope you will have a member of your staff contact me for further information.

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Not on Medicare but I would be interested in any response you get …

Hi David @dkollitz, I think you are trying to begin a war when there really isn’t anything more than spilled milk.

I’ve found that working with Medicare is not difficult as long as one reads instructions and fills in ALL blanks - yes, it may be tedious and working with people who demand the same proof over and over. Also, you do not mention the name of your third-party supplier.

I receive both my Tandem t-Slim Pump and pump supplies and my Dexcon G5 / G6 System and glucose sensors through Byram which has three very simple avenues for ordering and re-ordering supplies. To make things very simple on reorders, a week before order-date I receive a text on my 2005 flip-phone asking if I want to reorder; all I need to do is enter a #1 and my order is filled automatically. SIMPLE, Simple, simple!

If you have travels planned, all you need to do is open the Byram web-page, log on and enter the address where you want product shipped; and FedEx keeps you informed continuously until you have received the shipment. Really Convenient.

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David, I agree with you! Being TD1 since the age of 12 and now retired on Medicare, I have been through all of the medical progressions of therapies for the TD1 population. But, being on Medicare has been my most difficult lifetime experience.

Medicare requires us to prove ourselves in multiple ways to avoid fraud (fraud: receiving even one set of supplies beyond our current need). Seems like they want to make sure we are still alive and using the supplies.

My supplies come from Dexcom (now using G6 with Tandem Control IQ [another story!]):

  1. Sensor ordering is scary. Dexcom G6 sensors last for 10 days, I am on the last one with 7 days left, I tried ordering online and calling to make certain I get the box of three in time, but have trouble doing so.

  2. Today, “The Dexcom Store is currently not working correctly.” Often I call and get the message the store is not open. There are many levels of phone prompts to wade through to find out the store is closed. Wish Dexcom would give hours of operation first! So much wasted time to hit a brick wall!

  3. I request a return phone call, as Medicare’s rule is, “You must ask for refills for your supplies.” This puts the burden of getting supplies on the customer, not the supplier.

  4. A representative will eventually call from a Mexico Call Center. I have never had one that speaks English well enough to even be able to say the word “Dexcom”. I assume they are prank calls and have nearly hung up on them.

  5. Apparently, Medicare (Dexcom?) requires an in-person voice verification of need for supplies: chart notes, date of last Dr. visit, number of current supplies on hand, verification of address, etc.

This “Grand Inquisition” every 30 days is ridiculously annoying and time consuming. I am exceptionally busy and this intrusion in my life has me considering flushing the CGM/pump down the toilet, return to syringe and vials, and, if I could still purchase it, affordable beef-pork insulin. Maybe I will try Dennis’ route and try Byram!

I am sorry for your frustration. I am confused however when you say you can only order your glucose monitoring supplies for 30 days at a time. I too am on Medicare and am able to order all my supplies for 90 days.

It seems to depend on the insurance company. I have an Essence Medicare Advantage plan, and I can get 90 days of supplies for my pump. For the DGM, I can only get a 30 day supply. All supplies come from CCS Medical, and while I can check my order status on line, I must call CCS each time I reorder and answer the same questions each time. No one gives a coherent reason why that is, so I suck it up and play the game. Frustrating? Yes. That’s why I call in the afternoon and follow the call with a cold beer.

I have no problem getting my pump supplies for 90 days. I had a nightmare with Byram. My doctors notes were not compatible with Medicares requirements after a year of dealing with Byram. After many phone calls with Medicare who never received the claim and with Byram who would not tell my doctor what was actually wrong I left the company. I now use the same company that I get my pump supplies from. Hopefully no more problems, Dealing with Medicare and their rules is a nightmare. I have had many arguments with them and it is a losing battle. I have been a T1D for 50 years and I don’t think I will be cured anytime soon–somehow Medicare doesn’t understand that.

I too have the same frustrations with Medicare. Can you imagine if our health system becomes Medicare for all??? I think about the kids with T1D. What a nightmare!!!

I’m T1D for 55 years and just graduated to the Dexcom G-6 and the Tandem Control IQ system and I am having the same issues with Medicare, Dexcom, and Humana, my Medicare Advantage provider. I have spent hours upon hours on the phone trying to get my delivery refill date adjusted so I won’t run out. My first delivery was on December 27 so my refill date is the 27th of each month. I started my first sensor on December 31 so my change dates were January 10, 20, 30, February 9, 19, and so on. My refill will be reprocessed on the 27th and I will need it by the 29th. Does the person I spoke to understand the problem? A little. Can the refill date be changed? After hours on the phone, not yet! I’m leaving on a 3 week vacation on the 29th and have been assured that the order will arrive. I won’t hold my breath!

I had many similar situations when ordering the G5, including being without for a week or more. At one point I vented my frustrations with my Diabetes Educator and my Endocrinologist. They were told by the Dexcom rep about expanding and reorganizing. Fortunately, things did improve.

Since I didn’t start using my G6 immediately after it arrived, so far, I’ve been receiving my orders in plenty of time. After my attempt to place an order on-line fails, I call when I think they are open. Considering I’m in the Eastern time zone and Dexcom is PacificTime Zone, it can be annoying when no one answers. I agree that their customer service is poor. When I had problems ordering G5, either they didn’t return calls or I couldn’t understand them on the phone. Sometimes when I was concerned about a delivery arriving late, they did send by FedEx Express, instead of FedEx Ground Delivery.

Yes, I’ve also thought about the problems that might arise with Medicare for All. I doubt if the people in favor of it have experienced any of this government red tape!

Hi Donna and Dennis,
Dennis, there are different Medicare plans and supply ordering varies depending if we use “Pharmacy Benefit” (Part D) or “DME Benefit” (Part B). I changed from a Medicare Advantage Plan (Part D Pharmacy Benefit) to Regular Medicare/Plan F supplement (Part B DME Benefit) just before I aged out from being able to do so. The reason - cost! On Dexcom’s website - “Patients who do not have a pharmacy benefit should follow up with Dexcom for a DME benefit coverage check.” With DME, we cannot go to third- party wholesalers - our supplies come directly from Dexcom. Plan F is so popular, Medicare stopped it for 2020, Plan G is the next best.

Donna - No matter if you are under Medicare Part B or D, prescribing info is the same, BUT, it has changed from G4/5 requirements to new G6 requirements.

Rules to prescribing physicians for G4/G5 Sensors:

  1. Dispense 1 box (24 sensors/28-day supply)/ 13 refills

Rules to prescribing physicians for G6 Sensors:
2. Dispense 3 pack every 30 days

There is no refill to be had with the G6. The end user must forge through the re-order process every 30 days - therein lies the frustration!

Quite the contrary @SweetiePie.

Since I retired 10 years ago, my Medicare insurance has been United Health Medicare Advantage. My Tandem Pump supplies, and my Dexcom G5 & G6 glucose monitoring supplies are provided through Byram, always on time, all at zero [$0.00] co-pay. I just today received my “Medical and Hospital Claims Processed in January 2002” EOB, not the pharmacy Part D EOB which came yesterday, which indicates two payments to Byram an my $0.00 cost.

You’ve already heard this from some others here, but I’ll add my 2c. This really doesn’t seem like a Medicare problem. It seems like a problem with your particular medical insurance carrier (who may, however, be using Medicare as a scapegoat). I use Medtronic pump and CGM, so that’s different. But Medicare approval for my supplies is done annually, always in a timely fashion, and my supplies are mailed to me every three months by Medtronic, well ahead of any need.

I don’t think a congressman is going to be any help, even if he wants to help. Sorry.

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