In a welcome reversal of past policy, Medicare (CMS) will now cover the Dexcom G5 CGM system. For now, the Dexcom G5 is the only CGM system that meets the requirements set by CMS, so it is the only system that will be covered. The One Touch Vibe Plus (which contains the G5 CGM) should by extension also be covered. The Medtronic system, the T-Slim G4, Animas Vibe, and the Dexcom G4 would as of now not be covered.
The requirements for coverage were announced in March 2017. Patients must meet all of the following requirements:
1) Have a diagnosis of diabetes mellitus (note that this does not distinguish between type 1 and type 2 diabetes);
2) Be treated with an insulin pump or multiple daily insulin injections;
3) Be monitoring by fingerstick 4 times a day (so you need a record of 30 days of 4 fingerstick readings a day, even if you have already been on CGM); and,
4) Need to make frequent changes in insulin doses.
Thus, nearly anyone with diabetes who is on intensive insulin treatment can qualify for this critical life changing technology. Companies that have contracts with Medicare can process claims now. A prescription from a physician is still needed, so talk to your doctor if you are interested.
The welcome decision represents a tremendous victory for the diabetes community, after more than a decade of effort. Literally thousands of people expressed support to their congressional representatives for the need for Medicare coverage of CGM, and tried to educate their representatives on the critical need for CGM. Public support was mobilized by JDRF, DiaTribe, The Type 1 Diabetes Exchange via myglu.org, and many other organizations. As of the end of the last congress, a majority of both the House of Representatives and Senate were co-sponsors of a bill to force coverage. Though the bills were not voted on, their broad bipartisan support increased pressure on CMS to reconsider the policy. Dexcom also put a lot in to a multi-year effort necessary to meet the CMS coverage requirements. Professional organizations that represent the interests of people with diabetes- the Endocrine Society, the American Diabetes Association, the American Association of Clinical Endocrinology, and JDRF- also fought hard for years to bring about this welcome change in policy. We at Maryland Endocrine would like to thank those at CMS who made the decision to offer CGM coverage, and to those who worked so hard to pave the way for this welcome change. There can be power in numbers!