![]() ![]() I understand that these Samples will not be provided to any patients that are beneficiaries under the Maine or Colorado state Medicaid programs. Please note that if the patient of this pack is a Medicare beneficiary and the individual elects to continue using Dexcom G6 after this sample, the individual will need to obtain a medically necessary Dexcom receiver in order for Medicare coverage to be available. Accordingly, the treating healthcare provider should exercise their clinical judgment, in consideration of the Dexcom G6 Instructions for Use, to only dispense this pack to a patient who (or whose authorized caregiver) (i) has reliable access to a compatible smart device and/or automated insulin delivery system, and (ii) is capable of safely using the products in this pack with their smart device, without the need for a separate dedicated receiver. In the event you determine that the Dexcom receiver is medically necessary for your patient during the limited evaluation period, the receiver can be separately purchased from Dexcom. This pack includes one (1) Dexcom G6 sensor and one (1) transmitter and does not include a dedicated receiver. Dexcom G6 is FDA cleared for use with a separate piece of durable medical equipment called a receiver. I understand that these Samples include packs containing the Dexcom G6 Continuous Glucose Monitoring System (“Dexcom G6”). I also agree to inform my patients that no claims may be submitted for any Sample Pack. I understand that these Samples are being requested for the medical needs of my patients and that I will not sell, resell, barter, return for credit or seek reimbursement for these Samples. 2022:19322968221099879.īy submitting the above form, I certify that I am a licensed practitioner, authorized to request, receive, and dispense these Samples. MMIT Analytics, June 2022.Ĩ Shah VN, et al. 2021 69-72.ħ Managed Markets Insights & Technology, LLC. §§Savings based on $200 off retail cash price of monthly sensor pack and $200 off transmitter over 3-month period.ġ Beck RW, et al. JAMA. ‡‡This predictive alert can be triggered with impending hypoglycemia (glucose of 55 mg/dL or below is predicted to occur within the next 20 minutes). An internet connection is required for patients to send their glucose data to Dexcom Clarity via a compatible smart device: /compatibility. **Patient must first sync their Dexcom G6 data with the Dexcom Clarity app and consent to share their data with their healthcare provider. Followers must have compatible smart devices to use the Dexcom Follow app. Followers should always confirm readings on the Dexcom G6 app or receiver before making treatment decisions. Internet connectivity required for data sharing. ¶MARD is a statistical measure of accuracy. ![]() ||Comparison of NPS scores of Dexcom, Abbott, and Medtronic, Seagrove Survey 2021 Patient Perspectives. Actual cost may vary and is subject to individual insurance coverage. §Refers to estimated out-of-pocket cost for eligible commercially insured patients from the Dexcom G6 sensor when claims are adjudicated as a pharmacy benefit, and includes benefits and offerings through available Dexcom programs, such as the voucher program. †To learn more about insulin pump integrations and compatibility with Dexcom G6, visit /g6/integrations-and-compatibility. For a list of compatible devices, visit /compatibility. Users should always confirm readings on the Dexcom app or receiver before making treatment decisions.*Smart devices sold separately. To view a list of compatible devices, visit Separate Dexcom Follow app and internet connection required. †Compatible smart devices to use the smart devices and the Dexcom Follow app. *The Dexcom G6 Sensor and Transmitter and Dexcom G7 sensor are water-resistant and may be submerged under eight feet of water for up to 24 hours without failure when properly installed. *If your glucose alerts and readings from Dexcom CGM System do not match symptoms or expectations, use a blood glucose meter to make diabetes treatment decisions. *Fingersticks required for diabetes treatment decisions if symptoms or expectations do not match readings. The Dexcom G6 Continuous Glucose Monitoring System (Dexcom G6 System) is a real time, continuous glucose monitoring device indicated for the management of diabetes in persons age 2 years and older.įor complete safety information on Dexcom, visit: The Dexcom G7 Continuous Glucose Monitoring System (Dexcom G7 CGM System or G7) is a real time, continuous glucose monitoring device indicated for the management of diabetes in persons 2 years and older. ![]()
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