We’ve put together a few tips to help ensure a seamless experience in getting your patient’s Dexcom G6 Continuous Glucose Monitoring (CGM) System prescription filled.Many of your commercially insured patients have pharmacy benefits for Dexcom G6. endobj
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If so, please provide documentation including medication names and clinical reasons. this document. The CVS/Caremark prior authorization form is to be used by a medical office when requesting coverage for a CVS/Caremark plan member’s prescription. Dexcom G5/G6 Sensor/Transmitter Request: Will you also be requesting a prior authorization for the reader/monitor, does the patient already have the corresponding Dexcom G5/G6 reader/monitor, or will the patient be using their mobile device in lieu of the Dexcom G5/G6 reader/monitor? How Much Are Cialis and Tadalafil at CVS, Walgreens, & Walmart in November 2019?. Headquartered in San Diego, California, Dexcom has emerged as a leader of diabetes care technology. CVS/Caremark Prior (Rx) Authorization Form. For specific information, visit www.hmsa.com or contact a CVS Caremark Customer Care representative. endobj
Control Specialty Formulary™ The CVS Caremark ® Performance Drug List for Clients with Advanced Control Specialty Formulary™ is a guide within select therapeutic categories for clients, plan members and health care providers. Filling an Rx for Dexcom CGM is easy and timely. <>
If yes, please answer the two questions below. endobj
Find out if your patients have coverage by e-prescribing Dexcom G6 today. Excluded NDC 69336-0126-15 has a per-unit WAC of $71.42, while pharmaceutically equivalent GPI competitors have WAC pricing of $2.20 per unit. Generics should be considered the first line of prescribing. %����
Dexcom G5 sensors, Dexcom G6 sensors, Freestyle Libre 10 day sensors, Freestyle Libre 14 day sensors, Dexcom G5 transmitters, Dexcom G6 transmitters Refer to the durable medical equipment benefit (DME) for coverage of all other CGM monitors and supplies. stream
BRIEF SAFETY STATEMENT Failure to use the Dexcom G6 Continuous Glucose Monitoring System (G6) and its components according to the instructions for use provided with your device and available at Dexcom, Dexcom G6, Dexcom G4, and Dexcom CLARITY are registered trademarks of Dexcom, Inc. In the United States and/or other countries. Generics should be considered the first line of prescribing . January 2019 Performance Drug List - Standard Control for Clients with Advanced Control Specialty Formulary™ The CVS Caremark® Performance Drug List - Standard Control for Clients with Advanced Control Specialty Formulary™ is a guide A physician will need to fill in the form with the patient’s medical information and submit it to CVS/Caremark for assessment. _____ Is the request for Diabetic Test Strips? For example, CVS’s formulary excludes benzonatate NDCs 69336-0126-15 and 69499-0329-15. When prescribing a Dexcom CGM System to a Medicare patient, the Certificate of Medical Necessity is a required part of the document package for Medicare reimbursement. Get hired. Patients who do not have a pharmacy benefit should follow up with Dexcom for a DME benefit coverage check: Toll-free phone: 1-888-738-3646 (Monday - Friday, 6 a.m. to 5 p.m., PT; Saturday, 8 a.m. to 12 p.m., PT) To return to our website, simply close the new window. <>>>
This form...Dexcom, Inc. empowers people to take control of diabetes through innovative continuous glucose monitoring (CGM) systems. For a product that … 1. July 2018 Performance Drug List - Standard Control for Clients with Advanced Control Specialty Formulary™ The CVS Caremark® Performance Drug List - Standard Control for Clients with Advanced Control Specialty Formulary™ is a guide