How much Dexcom costs, Which insurances cover Dexcom?

3 sensors of Dexcom G6 cost around $350. 3 sensors are typically 1 month supply. You need to change the sensor every 10 days.
You will also need a transmitter. You need to change the transmitter every 3 months. The price of the transmitter is around $250.
And receiver, albeit not necessary, but if you choose to use it you will need to spend anywhere from $200-$350 depending on where you buy it.

If you have a smartphone and Dexcom clarity app you will not need to use the receiver. Although some people prefer receiver only and some people prefer to have a receiver and the smartphone app for Dexcom clarity.
The cost of Dexcom G6 will depend on your insurance. Which insurances cover Dexcom? Well, that depends and it is constantly changing. The prices above are cash prices with no insurance. Dexcom G7 is not in the market yet. I believe the price of the G7 will be very similar to Dexcom G6 or even cheaper.

gress and be available at all times.

Is Dexcom G6 worth it?

Dexcom G6 cost
Is Dexcom G6 worth the cost?

Is that expensive? Hell yeah? Is it worth it? That depends on your needs. You will need to consult with a diabetes doctor/endocrinologist to really understand your needs. You can also watch our YouTube video to understand if you really need Dexcom G6.

I do know where you live in but most people cannot afford hundreds of dollars monthly with or without insurance. Yet, my service still helps patients to get their diabetes under control regardless of the device they use. My team also works with insurances to try to get the best coverage for our patients. It is hard work. It can take sometimes hours. Patients get frustrated when the process goes more than a few weeks. Unfortunately between the Dexcom company, the insurance company in our office can be a tremendous amount of paperwork.

If you have any insurance coverage is likely. On the other hand, there is no guarantee that your insurance will cover Dexcom G6. We will talk more about insurance coverage of Dexcom G6 below.

Which insurance covers Dexcom?

Which insurance Covers Dexcom?
Which insurance companies cover Dexcom?

Some insurances will cover Dexcom based on certain criteria.  The easiest indication for Dexcom G6 or Dexcom G7 coverage by insurance is insulin use. If you are on 3 or more injections a day and you are testing your blood sugars at least 3-4 times a day you will qualify by Medicare criteria. I do not know any insurance company who will totally deny Dexcom accept Medicaid.

The same thing applies to freestyle libre CGM. They typically request endocrinologist records. If the insurance company does not see the doctor’s note saying that the patient is checking blood sugars 3 times a day and taking insulin at least 3 times a day insurance company may deny coverage immediately. On the other hand, I have also heard from my patients that the insurance company will call the patient directly and ask them if they check their blood sugars and record them. If they say anything other than what they want to hear they will send the rejection letter.

A lot of times in my office we have to do an appeal for the denials. The insurance company has nothing to lose by denying coverage.

Is an endocrinologist my goal is to give the best possible care to my patients. I want him to be able to monitor their blood sugars free of worry. So my goal is to have the insurance company to pay for the Dexcom G6 or soon Dexcom G7.

Nobody wants to prick fingers 4-5 times a day. Not only that, using Dexcom empowers patients over their blood sugar levels. They understand exactly how their blood sugars responded to diet and exercise. It becomes a very important safety feature. I believe Dexcom G6 and soon Dexcom G7 will become much more widespread. I also believe that the cost of Dexcom will go down as a production capacity goes up. Insurance companies will be more and more willing to cover Dexcom G6, Dexcom G7, or freestyle libre. If you want to learn more about the differences between Dexcom G6 and freestyle libre please read our Dexcom G6 versus freestyle libre article.

Most common criteria the insurance companies are looking for to cover Dexcom G6:

  • Hospitalization for diabetes recently
  • Frequent low blood sugars (hypoglycemia)
  • Labile blood sugars (fluctuating blood sugars)
  • Insulin-dependent type 1 diabetes
  • Insulin-dependent type 2 diabetes

 

Do you really need Dexcom?

A lot of my patients will want to use Dexcom G6 or freestyle libre just avoid fingersticks. Unfortunately, if you are only taking metformin or only oral agents for diabetes, none of the insurances will cover Dexcom G6. Insurance companies go by medical necessity not necessarily patient convenience. I am all about patient convenience for my patients. On the other hand insurance companies are there to protect their own interests. These devices are expensive and if insurance companies start covering Dexcom for every patient with diabetes the insurance premiums will skyrocket. But do you really need Dexcom G6? Do you really need to carry a device on your body when you can check your blood sugar with a fingerstick a few times a week?

Do you really need Dexcom? Watch this.

Most of the time patients checked her blood sugars excessively. This happens when they are newly diagnosed when they are obsessed with their blood sugars. The truth of the fact this if you are not on medications that cause low blood sugars and your blood sugars are typically in the same or similar range there is no need to keep checking blood sugars every morning or every evening.

Is Dexcom durable medical equipment?

Although both Dexcom G6 and Dexcom G7 are considered durable medical equipment (DME), nowadays endocrinologist/diabetes doctors can transmit a prescription electronically to a local pharmacy. Depending on the insurance coverage you may pick up your Dexcom just like picking up a prescription. That is been a good day if you have good insurance. Most insurances as we discussed will recheck to claim the first time and ask for further evidence that the patient needs Dexcom G6 or Dexcom G7.

Persistence and perseverance is the key. It takes a lot of time and effort for the doctor’s office to deal with the insurance requirements and paperwork. I sometimes joke with my patients and tell them if I was a lawyer charging you hourly he would get if you would get a $2000 bill for the number of hours we work to get these things done. I am glad we doctors do not work or charge like attorneys. I am sure you are too.

Dexcom clarity

Dexcom clarity allows patients to upload glucose data from a CGM device and then view the data easily. Endocrinologist/diabetes doctors can also see uploads even remotely. Patients and doctors can see trends, glucose statistics on a day by day basis. Patients can also email them to their endocrinologist/diabetes doctor. So in this COVID-19 era being able to communicate with your endocrinologist/diabetes doctor Is very important. My team will always be on your side to manage her diabetes to the best of your and our ability.

Dexcom parts

Dexcom G6 Dexcom G7
Dexcom parts

Dexcom is composed of a receiver, a transmitter, and sensors.
The receiver is a device that communicates with the transmitter to show the glucose data on the screen. Dexcom clarity app does the exact same thing. So, you will not need a receiver if you are using the Dexcom clarity app. Some people prefer to have both on the other hand. Both the receiver and your Dexcom clarity app will also show blood glucose trends. You will see arrow indicators on your screen for both Dexcom G6 and Dexcom G7.
The glucose in the interstitial fluid is sensed by the sensor and transmitted to the transmitter.
You will need to replace Dexcom G6 or Dexcom G7 transmitter every 3 months. You will need to replace the sensor every 10 days. Some people find ways to extend the life of the sensor however, that is not FDA approved.  There are some tricks that some of my patients use which primarily extends or actually doubles the life of the sensor. Again there may be some safety concerns here.

When is Dexcom G7 going to be available?

We know you guys have been enjoying Dexcom G6 very much. Soon Dexcom and Verily are planning to lounge Dexcom G7. My initial impression is that Dexcom D7 is going to be thinner. Hopefully, it will be less expensive. according to Dexcom G6 is going to be a fully disposable continuous glucose monitor. Due to COVID-19 and coronavirus pandemic, I believe the timeline for Dexcom G7 to hit the market will be delayed. The best expectation would be the end of 2020 or early 2021.

Dr. Ahmet Ergin
Dr. Ergin is the founder of SugarMDs.

Join our community at SugarMDs and see Dr. Ergin and his team. You will be glad you did because we provide the best concierge service for patients with diabetes. We do everything in our power to get through the best possible care and diabetic devices such as Dexcom G6, Dexcom G7, or freestyle libre. We not only help you get coverage but also remotely monitor you and treat you. You do not have to wait for the doctor’s office or beg your doctor to see and interpret your Dexcom data. Make sure you visit our YouTube channel and Facebook. Be part of our community.

Author: Ahmet Ergin, MD, FACE, CDCES, ECNU
About the author: Dr. Ergin operates a large diabetes practice mostly in West Palm Beach, FL, and yet can see diabetic patients across the entire state of Florida via a unique telehealth platform which also allows him and his team to track patient progress and be available at all times.

 

Leave a Reply