Dexcom Works to Bring CGM to the Medicare Population, and More

Nearly 1 year ago, on January 12, 2017, CMS made an historic policy change that allowed Medicare beneficiaries to gain coverage for the Dexcom G5 continuous glucose monitoring (CGM) system. The change came after years of work by Dexcom to present evidence supporting the change and advocacy from groups like JDRF, which culminated in a daylong hearing before an FDA panel; an expanded indication for the Dexcom G5 paved the way for CMS' move.

As 2017 would show, in some respects, that was the easy part. In March, the details of the new durable medical equipment policy appeared, and the hard work of getting CGM systems to waiting Medicare beneficiaries would begin. CMS’ policy change—the creation of a new benefit category, “therapeutic CGM”—would cover those with type 1 diabetes (T1D) and those with type 2 diabetes (T2D) on intensives insulin therapy. But even though many CGM users had already become accustomed to putting data on their smartphones (or sharing it with a spouse or caregiver), Medicare would not allow beneficiaries to use this Dexcom feature if they wished to have coverage. Many technology experts and advocates hope CMS will reverse this decision, since it will affect innovation down the road.

In an interview with The American Journal of Managed Care® (AJMC®) in late 2017, Dexcom Executive Vice President and Chief Commercial Officer Rick Doubleday spoke about the Dexcom G5 being the first CGM system approved by Medicare, along with efforts o bring it to beneficiaries. After the FDA panel’s approval in July 2016, Dexcom CEO Kevin Sayer announced the company’s commitment to bringing CGM to people with diabetes in Medicare—and as Doubleday discussed, it’s happened faster than anyone expected.

Doubleday also discussed a new partnership with Fitbit, and the opportunities for expanded use of CGM among those with T2D.

AJMC®: Can you describe how Medicare beneficiaries have responded to the news about reimbursement for the Dexcom G5? What steps has Dexcom taken to respond to demand?

Doubleday: Medicare beneficiaries are thrilled that the Dexcom G5 is now being reimbursed [for] those beneficiaries that have diabetes. We are the first one to get a class for Medicare beneficiaries to actually get continuous glucose monitoring. Continuous glucose monitoring is a tool that individuals with diabetes using insulin can actually get continuous glucose readings which helps them better manage their disease. It has alerts and alarms which will alert them when they are going either high or low, so these beneficiaries who frequently suffer from hypoglycemia, hypo-unaware, are thrilled that they now have access to this technology.

AJMC®: How is the Medicare reimbursement process going and how has Dexcom set itself up to respond to demand?

Doubleday: Medicare reimbursement is going well, one thing that everyone has to remember is that we are about 18 months ahead of when we expected to get the reimbursement and so, we’re playing catch-up. We would all like the beneficiaries to be getting these devices faster than they are, but we have ramped a team to be able to support them and we are continuously growing the number of patients that are getting the device.

AJMC®: Will Medicare revisit the decision to not allow beneficiaries to use CGM with their smartphone?

Doubleday: Dexcom is always the first to the market, and we’re the first to actually get the Medicare reimbursement. And when Medicare- and we’re thrilled that CMS made a decision to cover continuous glucose monitoring. As part of that ruling, we’re classified as a Medicare part B, which is a durable medical equipment. Part of that is you have to use the durable device, which is the receiver, and we are getting the benefit to patients. We are actively working with CMS to try and open up access to the smartphone. We believe that it’s very important for these beneficiaries to have the ability to use their smartphones. We will continue to work on this and when there’s more information we will absolutely share it with these beneficiaries.

AJMC®: Tell us about what’s ahead in the pipeline—when will we see the dime-size sensors that we’ve heard about?

Doubleday: Dexcom’s innovation is always about how do we make our devices more effective, less costly, and even more convenient. Our next product, our Gen 6 product, which we are planning to file with the FDA soon, is another example of that. It’s a smaller transmitter with fewer calibrations that will be even more convenient for individuals to use. As we look into the future, things that we are constantly looking at are how do we make the device smaller, how do we make the device more convenient, and how do we take cost out of this system, because we know that is so important.

AJMC®: How else are payers—both commercial and Medicare/Medicaid—affecting diabetes technology?

Doubleday: Payers are continuously looking at ways to drive outcomes. They’re looking at ways to decrease costs and drive outcomes. Dexcom is very much committed to that same belief. We know that healthcare is an expensive investment for the government as well as for other payers. Our focus is how do we make our products even more effective, [and] drive greater outcomes, which ultimately drive costs out of the system. Then, how do we take costs out of our systems to provide that same savings to government and payers.

AJMC®: What are the opportunities for Dexcom in the Type 2 market?

Doubleday: Dexcom has many opportunities currently, even in the Type 1 market. The opportunity in the type 2 market, I believe, is endless. Opportunity in the intensively treated, they have the same hypoglycemic issues, the same hyperglycemia issues as a type 1 so there’s all kinds of benefits with Dexcom’s technology. The alerts and the alarms, the real time continuous glucose monitor for them to see the results and prevent the highs and lows. As we look beyond that into the non-intensively treated, continuous glucose readings are a great behavior modification too. You actually see the impact that your food has on your glucose, the impact exercise has on your glucose, the impact your medication has on your glucose. All of that you can see through a Dexcom device, and I think that in the future there is going to be great opportunity for Dexcom in the non-intensively treated type 2 space.

AJMC®: How did the partnership with Fitbit come about?

Doubleday: The partnership with Fitbit is all about Dexcom and how we look to innovate. One of the key things that we do is we look at innovation; how do we make products more convenient for the users. Medicare users are looking for the convenient ways to use the device. Fitbit, especially with their new watch, allows an individual to get glucose readings in a place that’s more convenient for them. The nice thing about the Fitbit watch is it [is compatible with] both IOS and Android, so it’s a great opportunity in this partnership to be able to get beneficiaries their glucose readings on another device.

AJMC®: What can Dexcom users expect from this relationship?

Doubleday: Dexcom users can expect this relationship with Fitbit to, again, be another example of Dexcom working to provide more convenient tools for people to view their glucose results. We will continue to look at other innovations as to how we can continue to make this device even more convenient moving forward.

AJMC®: What will this partnership mean for expansion of CGM use in the type 2 population?

Doubleday: The Fitbit relationship is obviously a tool that will help patients be more convenient in how they see their glucose values. With Medicare’s decision to cover CGM, that includes both Type 1 and Type 2’s, so these individuals will be able to have the opportunity to see glucose readings onto another device. So, type 2’s will be equally as effective in those results as the Type 1’s.