New CGM coverage for Medicare customers

CGM coverage through Medicare

We know that for those with Medicare coverage, it’s been long awaited to have the Medtronic integrated continuous glucose monitor (CGM) covered, and we’re thrilled to announce that the wait is over. Medicare has officially expanded to include CGMs that integrate with Medtronic insulin pumps.

“This is a very important benefit expansion for our customers who have experienced the benefits from their integrated Medtronic insulin pump systems and are now able to receive coverage for all components of their system on Medicare” – Jeff Farkas, Vice President of Health Economics, Reimbursement, and Government Affairs for Medtronic Diabetes.

Wherever you are on your diabetes journey, we’re here to support you. We’re excited that this expanded coverage will open new opportunities for our valued customers like Terry.

"I've experienced tremendous benefits from integrated pump therapy, and I’m thrilled that this opens up access for many more people looking for ways to enhance their diabetes management." – Terry, Medtronic Diabetes Ambassador*.

For those currently on a Medtronic integrated CGM:

Starting immediately, those with traditional Medicare coverage will now place their orders for integrated CGM the same way they always have, either directly through Medtronic or from a secondary supplier. We’ll handle all of the backend work, which includes collecting your prescription along with other required documents required by Medicare for coverage. Once complete, we’ll contact you to ship out your transmitter and/or sensors and share with you the estimated cost to you.

For customers who are using the CGM Access Discount program, orders placed on or after February 28, 2022 will now go through your Medicare coverage. To keep your next sensor order running smoothly, we’d like to discuss changes in the price and make sure we have everything that’s needed.

Please call us at 800-646-4633, Option 2 (Monday – Friday 8AM - 6PM Central Time) for personalized support or visit our Medicare Support page to learn more. 

Please note that this coverage is only for those with traditional Medicare as well as a few Managed Medicare plans at this time. If you have a Medicare Advantage plan without coverage, we’re working through the details for coverage and will provide an update once your plan is able to process orders. In the meantime, people with a Medicare Advantage plan can continue to use our CGM Access Discount program.  

For those who are interested in getting on a Medtronic integrated CGM:

If you’re currently not using a Medtronic CGM with our integrated systems, but are interested now that there is Medicare coverage, we’d be happy to discuss next steps with you. Please call us at 800-646-4633, Option 3 (Monday – Friday, 8AM - 6PM Central Time) for assistance. To get answers to frequently asked questions, visit our Medicare Support page. 

Benefits of CGM: 

Adding a continuous glucose monitoring system to your diabetes management can provide you glucose readings every 5 minutes along with trends to help you treat your sugars before going high or low*. CGM systems give a view into glucose trends and can provide valuable information at crucial points throughout the day and night. To learn more about our Guardian Sensor 3 and how it works with our latest MiniMed 770G system, visit here

New to Medicare? 

Before you turn 65, visit with your healthcare professional to collect required documents and to prepare for necessary lab tests. In addition, it’s important to ensure your healthcare provider is an enrolled Medicare provider. Please note, this ruling is only available for integrated systems and does not include our standalone Guardian Connect system.   

 

*Refers to Smartguard™ Auto Mode. Individual results may vary. Some user interaction required. *Managed Medicare payers are currently working on providing coverage. In the meantime, qualifying customers can consider the CGM Access Discount program (terms and conditions apply) to receive a CGM and sensors at a low cost. *Aetna Managed Medicare has historically always covered CGM and is unlikely to have no changes with this ruling. UHC Managed Medicare will have coverage 2/28/22. *Medtronic Diabetes Ambassadors receive promotional items and educational material to use and share as the Ambassador sees fit. Opinions expressed by an Ambassador are based on the Ambassador’s actual experience and are not necessarily the opinions of Medtronic.  

 

IMPORTANT SAFETY INFORMATION MINIMED™ 770G SYSTEM WITH SMARTGUARD™ TECHNOLOGY

The MiniMed™ 770G system is intended for continuous delivery of basal insulin (at user selectable rates) and administration of insulin boluses (in user selectable amounts) for the management of type 1 diabetes mellitus in persons two years of age and older requiring insulin as well as for the continuous monitoring and trending of glucose levels in the fluid under the skin. The MiniMed™ 770G system includes SmartGuard™ technology, which can be programmed to automatically adjust delivery of basal insulin based on continuous glucose monitoring (CGM) sensor glucose (SG) values and can suspend delivery of insulin when the SG value falls below or is predicted to fall below predefined threshold values. 

The Medtronic MiniMed™ 770G system consists of the following devices: MiniMed™ 770G insulin pump, the Guardian™ Link (3) transmitter, the Guardian™ Sensor (3), one-press serter, the Accu-Chek® Guide Link blood glucose meter, and the Accu-Chek® Guide test strips. The system requires a prescription. The Guardian™ Sensor (3) has not been evaluated and is not intended to be used directly for making therapy adjustments, but rather to provide an indication of when a fingerstick may be required. 

All therapy adjustments should be based on measurements obtained using a blood glucose meter and not on values provided by the Guardian™ Sensor (3). All therapy adjustments should be based on measurements obtained using the Accu-Chek® Guide Link blood glucose meter and not on values provided by the Guardian™ Sensor (3). Always check the pump display to ensure the glucose result shown agrees with the glucose results shown on the Accu-Chek® Guide Link blood glucose meter. Do not calibrate your CGM device or calculate a bolus using a blood glucose meter result taken from an Alternative Site. It is not recommended to calibrate your CGM device when sensor or blood glucose values are changing rapidly, e.g., following a meal or physical exercise.

WARNING: Do not use the SmartGuard™ Auto Mode for people who require less than 8 units or more than 250 units of total daily insulin per day. A total daily dose of at least 8 units, but no more than 250 units, is required to operate in SmartGuard™ Auto Mode.

 

WARNING: Do not use the MiniMed™ 770G system until appropriate training has been received from a healthcare professional. Training is essential to ensure the safe use of the MiniMed™ 770G system.

Pump therapy is not recommended for people whose vision or hearing does not allow recognition of pump signals and alarms. Pump therapy is not recommended for people who are unwilling or unable to maintain contact with their healthcare professional. The safety of the MiniMed™ 770G system has not been studied in pregnant women. For complete details of the system, including product and important safety information such as indications, contraindications, warnings and precautions associated with system and its components, please consult http://www.medtronicdiabetes.com/important-safety-information#minimed-770g and the appropriate user guide at http://www.medtronicdiabetes.com/download-library.

 

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Blog comments

Submitted by Larry Martin (not verified) on

In reply to by Commenter (not verified)

So almost 2 years after CMS and Medicare ruled all sensors are covered, you guys finally get your act together. So so sad that you discriminated against us and forced us to pay thousands of dollars even with the discount program. And my US senator informed me it was all because you refused to change the label on the sensor packaging.

Submitted by Rae (not verified) on

In reply to by Larry Martin (not verified)

Larry, our CGMs did not meet Medicare's adjunctive criteria for coverage, as fingersticks are required. Our labeling has not changed (this would need FDA approval), but Medicare did change its policy allowing for coverage of our Guardian Sensor 3 Sensors. We are pleased with this update and we are continuing to work with Medicare to broaden their coverage of our Guardian Connect device.

Submitted by Jerry Chandler (not verified) on

In reply to by Commenter (not verified)

I have been approved to upgrade from the 670G to the 770G and I don’t have a time frame of when I can expect to receive it. I had been using the CGM for probably less than a year that I ordered from Medtronic and paid $180.00 copay for a 3 month supply. Medtronic advised me near the end of Feb 2022 that Medicare was covering the cost of the CGM’S for myself and said I would need to go through Edgepark ,who supplied my pump supplies, to get the CGM and new transmitter. Edgepark said I would would be charged around $7000.00 for the transmitter so I declined there offer. After talking with Medtronic about this Medtronic referred me to CCS MEDICAL who advised me that there would be no charge for me to get the transmitter and a 30 day supply of the CGM but I still have not been advised when I will receive any of the supplies and the transmitter.

Submitted by William Chris … (not verified) on

In reply to by Commenter (not verified)

Medicare will not cover the extensive use of test strips called for with the Guardian 3 system! Sometimes this system has required as many as 10 finger sticks in a 24 hour period. Many dosages have been administered without the required finger stick. Is it possible to educate Medicare on this system requirements for finger sticks?

Submitted by Rae (not verified) on

In reply to by William Chris … (not verified)

We continue to work with Medicare regarding our systems. In the meantime, we encourage you to work with your doctor's office and insurance for additional test strips. We'd also like to help see if we can help lessen your fingersticks. Our technical support team can review your CareLink with you and are available at 800.646.4633 option #1.

Submitted by Vicki (not verified) on

In reply to by Commenter (not verified)

My wife has been trying to get Medicare and Medicaid to pay for her CGM guardian 3 and has not been successful. Do you have any ideas on how to get them to pay for it and saying they are not covered

Submitted by Rae (not verified) on

In reply to by Vicki (not verified)

Vicki, if Medicare is currently covering her Medtronic insulin pump, sensors should be a covered benefit. If she's only using our CGM, she wouldn't meet Medicare's requirements, but we'd be happy to look into her Medicaid coverage and our cost support options. Please have your wife give us a call at 800.646.4633 option #3, to learn more.

Submitted by Donna Abbott (not verified) on

In reply to by Commenter (not verified)

Everything I read tells me I would be covered for a medtronic Guardian 3 CGM, but I have been told I do not qualify. I am a type 1 diabetic on a medtronic pump. I do not get it !!! Any suggestions?

Hi, Donna. I would recommend reaching out to our team via phone. Please give us a call at 1-800-646-4633, option #3, and one of our therapy specialists can help do an insurance check for you. Thank you!


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