Test strips are covered when medically necessary and prescribed by your physician. Medicare will reimburse either 80% of the Medicare Fee Schedule or the actual charges, whichever is less. Show
More questions about Medicare? Most blood glucose meters designed for at-home use are covered under Medicare Part B. These include multiple brands, such as:
Talk to your doctor about the glucose meter brands available and which one may be best for your specific needs. Is the FreeStyle Libre covered by Medicare?If a Medicare-approved physician prescribes the FreeStyle Libre CGM system, Medicare will cover the device if you qualify. You may purchase or rent a FreeStyle Libre from a Medicare-approved provider only. There are requirements to qualify, including:
CGMs provide continuous monitoring of your blood sugar levels. They maintain information about prior readings as well as your current reading. They also enable you to see the impact of eating, exercising, and other behaviors on your glucose level. Since CGMs utilize inserted sensors, they eliminate the need for most finger pricks. The sensors provide a sense of freedom for many people. How much does FreeStyle Libre cost with Medicare?If you have Medicare Part B, you can expect to pay 20% of the Medicare-approved cost of a FreeStyle Libre. You will also be responsible for meeting the Part B deductible, plus your monthly premium costs. Available to people with type 1 or type 2 diabetes on intensive insulin therapy. Another continuous glucose sensor option for people over 65 is now covered, in addition to Dexcom G5! This just in: Medicare will now cover Abbott’s FreeStyle Libre real-time continuous glucose monitoring (CGM) system. The news came in much faster than we had expected, only three months after the FDA approved the no-calibration FreeStyle Libre as a replacement for fingersticks and safe for dosing insulin. This also came quite fast after FreeStyle Libre launched last month in retail pharmacies in the US. Starting today, those on Medicare with type 1 or type 2 diabetes using intensive insulin therapy (multiple daily injections or a pump) now have access to two CGM systems: Abbott’s FreeStyle Libre (real-time) and Dexcom’s G5. The criteria for FreeStyle Libre coverage is identical to that for Dexcom’s G5. That is, someone covered by Medicare is eligible for reimbursement for either device if he or she:
As diaTribe understands it, Medicare will cover the following FreeStyle Libre components for those eligible (see this article for Dexcom specifics):
Unfortunately, the Libre system is unavailable in major retail pharmacies for those covered by Medicare. Instead, Libre will be available by prescription in the United States through Edgepark Medical Supplies, Byram Healthcare, Solara Medical Supplies, Edwards Health Care Services, Better Living Now, Mini Pharmacy, and Advanced Diabetes Supply. Those covered by Medicare for Dexcom typically pay approximately 20% of the costs of CGM themselves, or roughly $50 per month. (This additional amount may be covered by secondary insurance.) Medicare will typically cover the remaining 80%. We’d guess this out-of-pocket pricing is also true for FreeStyle Libre as Medicare has set them at the same pricing. Like Dexcom’s G5 bundle, FreeStyle Libre will require a prescription and will ship through mail order for those on Medicare. As mentioned last month, for those with private insurance or paying cash, FreeStyle Libre is only available in pharmacies. That the US Centers for Medicare and Medicaid Services (CMS) decided to cover FreeStyle Libre on such short notice is a positive sign. Dexcom paved the way for Libre with a two-year push to finally receive the first fingerstick replacement designation from FDA for G5 in December 2016, followed by CMS’s decision to reimburse in March 2017. Dexcom, in its early efforts to ship its G5 system to Medicare patients, experienced some reimbursement hurdles. However, as of the last update in November, over 4,000 individuals had received a G5 bundle through the mail, and Dexcom hoped to ship about 20,000 by the end of 2017. We’ll have to see if Abbott encounters similar challenges. Abbott’s FreeStyle Libre is different from Dexcom’s G5 in several key respects, including no alarms, no fingerstick calibrations, a longer 12-hour warmup, a 10-day sensor wear period that cannot be extended, a fully disposable on-body component, and a simpler insertion process. If you are eligible for coverage, we include some notes on key differences below. Even if you’re not on Medicare, Abbott’s website has an encouraging statistic: Most people with private insurance in the US pay no more than $75 per month out-of-pocket to get FreeStyle Libre. That translates to $2.50 or less per day, which is favorable compared to other options. Abbott says FreeStyle Libre is already as widely covered under private insurance as other CGMs, and its goal is further accessibility through the pharmacy. Conversations with insurers are underway. Could Medicare CGM even help those with private insurance? It’s possible, since many insurers look to Medicare for guidance. Now that Medicare has approved coverage for two CGM systems for type 1 AND type 2 intensive insulin users, it could nudge all private insurers to more widely cover CGM. This has been many years in the making, thanks to amazing advocates, the CGM companies, and Medicare. This is very positive access news to start the year for people with diabetes who are on insulin and who do not already have CGM. More Details and FAQ:
What are the key differences between the Medicare version of FreeStyle Libre and G5?
These product differences will change over time – some potentially this year. For instance, Dexcom’s next-gen G6 is currently under FDA review, with plans to launch before the end of 2018. It is currently under review for one fingerstick calibration per day and 10-day wear, but FDA discussions are also underway for a no-calibration version. Meanwhile, Dexcom’s next-next-gen sensor with Verily requires no calibration, will be fully disposable, and last 10 or 14 days. Abbott is currently developing a next-gen FreeStyle Libre as part of its Bigfoot partnership, which will add continuous communication to the FreeStyle Libre sensor. We’d guess it could add alarms too, but this is speculation on our part. What about CGM remote monitoring and app communication for Medicare users?At this time, app communication and remote monitoring are not allowed for therapeutic CGMs. Dexcom has had to turn off this function in its G5 Medicare system, a tremendous frustration for users due to the current Medicare reimbursement codes. We know that Dexcom is working to fix this, along with a number of patient and organizational advocates. Unfortunately, there is no timing to report, but we hope to see this policy overturned as soon as possible – remote monitoring of CGM data can save lives! Abbott’s FreeStyle Libre does not have an approved smartphone reader app in the US right now. Its LibreLink and LibreLinkUp apps are available outside the US, though we’re not sure when they’ll come to the US. Could any other CGM systems secure Medicare coverage this year?It’s hard to know at this point. Senseonics’ 90-day implantable Eversense CGM is currently under FDA review, but not for fingerstick replacement. This means that the first approval, which might come this year, wouldn’t make it eligible for Medicare coverage. A secondary submission for fingerstick replacement could follow at some point, and if approved, Eversense could qualify for coverage. Medtronic’s Guardian Connect mobile CGM is also currently under FDA review, with US launch expected by April. We’d guess that it will not be designated therapeutic CGM upon approval because (i) the product label for the Guardian-sensor-integrated 670G hybrid closed loop states that fingersticks are always to be used when taking a bolus; and (ii) three to four fingersticks per day are recommended. What about Medicare coverage for those not on intensive insulin therapy?At this time, Medicare coverage is only available to those that meet the criteria above. We feel very strongly that others at risk of hypoglycemia, especially those on sulfonylureas (e.g., glipizide, glyburide, glimepiride), should also have access to CGM. We will be working on advocacy on this front – let us know if you’d like to help. If you have other questions on Abbott’s FreeStyle Libre, Dexcom’s G5, and Medicare coverage, please send them here. What do you think?Do you recommend this article?42 readers recommendRecommended Share this article:Subscribe to our weekly newsletter & get more articles like this oneAbout the authorsAB Adam Brown Adam Brown joined diaTribe in 2010 as a Summer Associate, became Managing Editor in 2011, and served as Senior Editor through 2019. Adam brings almost two decades of personal experience... |