Medicare recipients using CGM and glucose test strips

All…I am on Medicare and use the Tandem T-slim X2 insulin pump with the Dexcom G6 CGM. I had a discussion with a representative from Medicare, a Durable Medical Equipment (DME) “expert” that told me that “all supplies associated with the CGM” should be covered by Medicare. I asked specifically about glucose test strips. She said they should be covered. When I go to the pharmacy, they tell me Medicare won’t pay for test strips because I have the CGM. Those who have this system know that you have to do calibrations just to verify what the G6 is telling you. My pump asks me to calibrate on a regular basis. Is anyone getting glucose test strips paid for by Medicare and using the Dexcom G6? I can’t find any specific documentation from Medicare that states specifically that if you use a CGM you can’t get glucose test strips. Even if I could get 2 strips per day would be helpful.

Thanks!

Hi @DONNY1953. Are you entering the code that comes with each sensor? If so you don’t need to calibrate, at least if you are using Basal or Control IQ. I don’t know if it works differently if you are using it without those advanced features though.

Donny @DONNY1953, hate to confirm for you that your pharmacy is correct. When CMS [parent organization for Medicare and Medicaid] authorized and approved the DexCom G6 for use by its beneficiaries, the ruling [October 17, 2018 if you want to look it up], specifically stated that BG Check Strips would NOT be covered by Medicare because the G6 has an “Non-Adjunctive” FDA Rating. Non-Adjunctive means that the CGM device readings can be used for insulin therapy without being corroborated by another source.

If yuo read the DexCom G6 User Manual, and read the flyer in the DexCom G6 box that you must remove to access the devices, and follow instructions, the pump will never be asked to be calibrated. At least my pump has never made that request.

Now a question for you: why do you think that information from a BG Meter is more accurate than the DexCom G6?

Thanks for the Dennis…If you could provide a link to this ruling it would be greatly appreciated.

My problem with the G6 is that it very rarely lasts 10 days for starters. Usually around the 5th or 6th day I start getting “no readings” alert followed by calibration error alerts. I’m getting low glucose and high glucose alarms fairly often and when I check with test strips it is usually 60-80 points different than what the G6 states. At that point, if I try to calibrate, the pump goes into the calibration error loop and at that point I might as well change the sensor because this loop can go on for hours. Most sensors are replaced in 7 or 8 days.

Next time the pump asks to be calibrated, I’ll take a picture and post it. FYI, I use basal IQ and have been reluctant to switch to control IQ because of the inaccuracy of the G6.

I might add that I only weigh about 160 lbs., and exercise regularly. I normally ride my bike anywhere from 90-150 miles per week and frequent the gym when I don’t ride. Either elliptical, treadmill or stair climber.

Donald @DONNY1953, it is a shame that the G6 doesn’t work properly with your body; does DexCom have an explanation? I too am slim, BMI just about at 20.0 and I occasionally get “compression lows” when sleeping, which I attribute to the sensor getting pushed up to where a rib interacts. Almost all my sensors have lasted the full ten days, except for one lot number which gave me “lost readings” intermittently on the ninth and tenth day.

The only time that I was asked by the Tandem pump to calibrate, was when I did a calibration when the CGM wasn’t giving a reading, and the pump wanted a “confirmation”. To double check my thought on that, I have done a calibration when a CGM reading was present, and at that time the pump did not ask for a confirmation.

I miss my afternoons at the gym, I haven’t been there since the first of March. My practice had been to eat lunch, ride my bike to the gym and do resistance work for 90 +/- minutes and then take a longer bike ride home.

I’ve cut back on my longer days on the bike after the cardiologist told me to act my age. I had complained to him about loss of stamina and tiring out too quickly. He and the techs put me through treadmill stress tests and ultra sound to identify my problem - as that afternoon was finishing, the tech told me that I was performing like an “old man of 55”. Right now, even with isolation, I’m greatly enjoying my 80th summer.

Old man of 55? What?? I thought 50 was the new 30!! - in which case you’ve got the heart of a 30 year old. Well done sir, well done. I would tip my hat to you but can’t find an emoji for that…

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Hi Donny,

I’m on Medicare and yes, Medicare does pay for my test strips, Dexcom G6 sensors, transmitters, and the new receiver when I upgraded from the G5. I get my strips with an Rx from my endo and fill it at a local Walgreens(Duane Reade). I’m on a different pump system–Omnipod–but I don’t know why that would make a difference. Besides, it states repeatedly in the G6 users guide to test if you don’t think the meter is accurate. So why include a “calibrate” function on the G6 meter if it has a “non-adjunctive” reading?

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