Medicare’s smartphone restriction of Dexcom G5 hurts patients

When I first wrote about Medicare’s guidance in covering the Dexcom G5 Continuous Glucose Monitor (CGM), I was concerned about some wording that suggested that Medicare would not allow the use of a smartphone as a secondary display. But even then, I thought there was NO way this limitation would actually be enforced…

Until a Dexcom rep came into my office and told me that “Medicare transmitters” would start shipping soon. These transmitters would be hardcoded to prevent pairing with the Dexcom G5 smartphone app. I was floored and incensed at the same time: Medicare required Dexcom to build custom transmitters that forbid users from using their smartphones!

While CGM approval by Dexcom is a huge win overall (it really is), restricting smartphone integration is absolutely ridiculous. Here’s why:

Smartphones make the Dexcom G5 better, and no worse

The Dexcom G5 Mobile system always ships with a receiver, even before Medicare got involved. The system is a fully functional medical device without a smartphone. Using an iPhone (or any supported smartphone) as a receiver greatly improves the experience and simplifies the cloud sharing process, but it’s completely optional. In fact, using a smartphone as a second screen is fully redundant, meaning that you can use BOTH a standard receiver and a smartphone at the same time. Adding a smartphone to the G5 equation only offers benefit. It does not change the functionality of the standard G5 components in any way.

Consider a backup camera for your car. For many tasks, the backup camera offers a better user experience than just using your rear view mirror and looking out the back window. The backup camera doesn’t replace the rear-view mirror, but it can only help. Once you’ve used a backup camera, it becomes very hard to go back. (I get anxious driving loaner or rental vehicles now).

Medicare’s decision to restrict smartphones is akin to forcing car manufacturers to disable rear-view cameras. The use of a backup camera literally doesn’t cause any harm or limitation to the standard rear view mirror. In fact, it is harmful and less safe to remove the functionality of a backup camera to a car, just as it is harmful and less safe to remove the added functionality of a smartphone to CGM.

Elderly people use smartphones too

I’ve written about digital health and iPhone health apps since the launch of the App Store with the iPhone 3G, and I’ve noticed two things: 1) People frequently incorrectly assume that older people don’t use smartphones, and 2) Older folks are fantastic at using their smartphone, especially for health monitoring.

While they might not be on Snapchat or Tinder in droves (yet), I’d argue that older patients are more consistent in their use of digital health tools. For example, 4 of the top 10 users of Sugar Streak (my diabetes app) are older than 60. My patients that most consistently bring in their data on self-created spreadsheets or use Apple Health or Samsung Health are over 60. The iPhone’s mass market appeal is why over one billion phones have been sold in the past 10 years.

But the purpose of this article isn’t to compare older vs younger people, and neither should the purpose of Medicare’s coverage of CGM. Why should a Medicare-covered G5 transmitter be inferior to a transmitter for a non-Medicare patient?

Allowing Smartphones would not require Medicare to pay for the iPhone

I’ve heard it argued that perhaps this restriction prevents Medicare patients from trying to require Medicare to reimburse the cost of the iPhone. I call BS.

If I can’t get Medicare to cover certain brands of medication, the CGM component of the Medtronic 670G (don’t get me started on that!), or a certain number of $0.50 test strips for my patients, then I’m 100% positive that Medicare can somehow find a way to block a $969 Apple iPhone 7 Plus. Here’s a suggestion for the rejection filter: “reject if manufacturer equals Apple, Samsung, LG, or Google.”

Conclusion: Medicare does not understand Digital Health

Look, I get that we should be immensely grateful that Medicare has gone so far as to finally approve their first Continuous Glucose Monitor. That’s a huge victory, and I applaud the folks at CMS for doing so. I even get why Dexcom isn’t fighting back very hard against Medicare. (Don’t bite the hand that feeds you).

But this doesn’t mean doctors and patients can’t complain about how ridiculous it is to limit the Mobile component of the Dexcom G5 Mobile System. Their decision shows a complete failure to understand the full potential for digital health.

Has anybody heard an argument for why restricting smartphone compatibility is a good idea? I genuinely want to know. As far as I can tell, it’s literally indefensible.

33 Comments
  1. This policy of not allowing smart phone use is ludicrous and for some will be deleterious. Having the ability to share data greatly increases safety by having another person follow and have alarms for low blood sugars. Not being able to review the data conveniently is detrimental to learning how to maintain good blood sugars and maintain control. This is our disease, not someones disease that sees you twice a year. We have to live with it day by day and minute by minute and have to become good at treating ourselves if we are to survive.

    I am a 30 yr Type 1 with little or no complications using low carb technique (i.e. Bernstein), now on Medicare. I need this data continuously and conveniently. Contrary to FDA opinion I do know how to use a smart phone having used them since inception, and surprisingly can even operate a computer and drive a car!! I suspect the percentage of all congressman in DC over 65 using smart phones is 100%. Is this age discrimination? How would a congressman feel if they were told they could not use their smartphone. Obviously those of us who are Type 1 and Medicare age are a small number with little clout.

    Using a smart phone with Dexcom should be an option and individualized. For Dexcom to be “forced” to turn off apps for a Type 1 currently using the system and then being forced to go backwards upon hitting Medicare age, is horrible. Perhaps this is a way of rationing the payments.

    I would hope and pray that Apple and other players in the smart phone medical device field would consider this a huge affront and obstacle to their innovations and take some action.

    Please let us not go backwards.

    Thank you for helping to bring this ridiculous requirement by Medicare to the forefront.

    Dan Jones

  2. My wife and I are on Medicare. She has type 1 diabetes (over 50 years). Currently, however she has Alzheimer’s disease and cannot take care of her diabetes at all so I do it for her. She has been using a pump and CGM for a number of years. Of course, as soon as we were on Medicare, CGM coverage was gone. It was great to hear Medicare has finally admitted that CGM’s are useful enough to cover. However, because of the restriction on phone usage, I can’t accept it.

    As an example of why it is so important to continue using my smartphone is the following. I’m with my wife most of the time but there are times when I can’t be with her. For example, once a week she is in adult day care. Even though they check her blood sugar every two hours and give her a bolus for lunch, sometimes things go wrong. More than once I have called them because I got an alert on my phone telling me her blood sugar was low according to the CGM. The nurse checked, it was low and they gave her sugar to raise it up. Without my ability to monitor remotely, there will be instances like this that would get a lot worse. Even though it doesn’t happen often, it isn’t worth the risk when we have a way of preventing serious problems.

    More commonly, when we are at home, I’m not always in the same room. I may not hear alarms on her receiver which is in her room, whereas I can hear them on my phone.

    I think I’m preaching to the choir. Hopefully, this stupid restriction by Medicare will somehow be corrected soon. In the mean time, it’s $300 per month.

  3. I am over 66 years old, type 1 for over 30 years. I was happy to receive the DexCom G5 under the Medicare program, then staggered to learn about Medicare working overtime to make sure a smart phone can’t be used with the system. DexCom told me to just “pay for it out of your pocket” like they were telling me to buy a candy bar for a $1. I can’t afford $5,000 each year for all the sensors and transmitters.

    My wife, who was thrilled that I got the unit was also shocked about Medicare’s strategy. I suffer from hypoglycemia unawareness after all these years and don’t always know when my blood sugar is in the 30s. The iphone connection could be a possible lifesaver in situations in which my wife is away and can receive low blood sugar notices like ALL other DexCom users not in Medicare. Why does someone have to die to satisfy the arrogance of government officials?

    Why do I have be treated with contempt by Medicare? Why can’t our government do even a simple step correctly? And why does DexCom partner with a government agency to collude against the medical interests of its own patients? This last point is not getting much publicity, is it? All the ire is focused on Medicare, when a big chunk of it should be focused on DexCom for rolling over, again, AGAINST THE BEST MEDICAL INTERESTS OF ITS OWN CUSTOMERS.”

    I would guess at some point that DexCom is going to be sued to its collusion with the government in this matter after someone dies. I hope DexCom pays a huge price for its dirty deal with Medicare!

    • Hi Bill, I hear your frustration and I think it’s important for us to voice our concerns, so thank you for doing that. I don’t think we should necessarily alienate Dexcom though, because obtaining Medcare approval for CGM (albeit limited) is a big deal and a huge boon for patients. We just need to continue to encourage Dexcom and Medicare to go the final steps in not blocking smartphone use.

  4. Let me first say how grateful I am that Medicare has decided to cover the CGM and thankful to Dexcom for obtaining Medicare approval. I am also in total agreement with everything said here on the G5 and the smartphone app. What can we as consumers do besides complain to each other? Can we telephone someone?, can we write a letter? I think it’s time we put our DM power together and get on those that supposedly WORK FOR US in the government.

  5. As a nearly life long Insulin Dependent Diabetic on SSDI who suffers from Unaware Hypoglycemia I’m outraged that Medicare has threatened to deny Continuous Glucose Monitor (CGM) coverage for ANY patient using the added safety feature via the smartphone app. This app allows users like me to share my blood-glucose readings with Drs and family before potentially life threatening low blood sugars (Severe Hypoglycemia) occor as well as alert EMS if needed! Meficare has even gone as far as to force Dexcom (the only approved CGM manufacturer) to block this app software for ALL Medicare patients as well as threatening ANY usage of this app will result in denied coverage and full reimbursement to Medicare!
    This app offers addition safety and Diabetic management for users and must not be restricted for ANY reasons. Especially soley for Medicare’s rediqulous concerns regarding possible smartphone covarge!

    Please contact your local Congressional Representatives and make this a top priority emediately! Together our voices cannot be ignored!

  6. I just changed over to the Dexcom G5 per my Dr’s direction for many reasons. The most important being the Dexcom APP which allows me to share my blood-glucose levels that are too low with loved ones. This is especially helpful to me being a life-long Type 1 now suffering from Unaware Hypoglycemia.
    I am however, confused and outraged that Medicare has blocked this added safety option of utilizing the APP in addition to the Dexcom receiver for ALL Medicare patients. They have gone as far as to make Dexcom create a different G5 meter (different packaging, software, and labeled Medicare) that blocks this APP feature. And they have threatened ALL patients that if found using the APP that any Medicare coverage will cease and ALL past coverage fees will be owed by patients!
    This is outrageous! Why are they blocking this potentially live-saving additional resource from Diabetics? How the hell can they get away this?
    All Diabetics must unite to demand that Medicare is forced to undue this absurd denial that can only hinder Diabetes Management. Together, our. Collective voice cannot be ignored!!
    I urge us all to contact our local elected officials to pressure Medicare to allow ALL Dibetics the ability to use the Dexcom APP in addition to the Dexcom receiver to better manage their blood sugars with this Chronic, Progressive, and Dibilitating Ilness!

  7. How is blocking my wife’s transmitter from communicating with her phone and therefore with my phone any different from forbidding my wife to tell me what her current blood sugar is? “We will cover your test strips but you must keep your numbers confidential!” ???

  8. I was diagnosed with diabetes 1 at age 72 (I’m 79 now) The idea of a CGM appealed to me and believed it would really help me to stabilize my glucose levels. Even though I was aware of Medicare’s regulations re not using a smart phone, I decided to go ahead and try it. The first week went smoothly and I wore the transmitter on my arm.The only thing I resented was the burden of carrying yet another monitor besides my phone which I carry anyway, and not being able to share my glucose levels. The second week was a disaster. As recommended by the manufacturer, I wore the transmitter on my abdomen this time. The trainer told me not to wear on the arm as it had not been tested on that site. The transmitter fell off twice as I pulled my pants up and down when going to the bathroom, and I was using the tape! Too much bother for an old lady so I went back to just the pump. When I called Dexcom with my decision not to use the CGM I was warned that If I wanted to re-start in the future it might be difficult to get it approved by Medicare. Personally, I don’t want Medicare’s approval unless they approve the use of the smart phone for tracking glucose levels.

  9. I have T1D for 42 years now and am wondering, Who exactly came up with this ludicrous requirement? Who fostered this brilliant idea? These same Medicare bureaucrats also insist that your CGM cannot communicate with your insulin pump. Seriously? Wouldn’t that improve overall care and well being of diabetes patients?

    Did Medicare officials consult diabetes patients, doctors, caregivers and IT professionals?

    I’m livid! Thanks Medicare for making our lives more difficult and unnecessarily complicated.

  10. My husband has been a t1 diabetic for 53 years. He just started using dexcon and it is great but would be better if Medicare allowed the use of his iPhone. It would be great if I could also be notified of his high and lows. Since I prepare our meals, It would help in menu planning and timing of meals.

  11. My wife was originally diagnosed as t2D but after several years the diagnosis was corrected to T1D. She started using the iPhone app as soon as she received her GCM but after only a week she was informed to stop using it or face losing her Medicare coverage. In that week we discovered how much better her control was with the app. She saw how much better her control was with the app only to have it taken away for no apparent medical reason. This loss of control was very depressing and it took her a while to get over her anger and disgust at having such a useful tool made unavailable.
    My question is simple. I have not heard anyone claim that there is a medically sound reason to deny the app. As a matter of fact, there is an app that provides similar feedback for heart patients (reported in the San Francisco Chronicle). So what, if any, medical reasons are cited to justify the withholding of the smartphone app for type 1 diabetics?

  12. The government has no business making medical decisions because they are politically oriented and therefore logically ignorant.

    The Dexcom receiver costs $500 and, in my case, that expense could be avoided if medicare would allow me to use the cell phone app instead. Why force users to use a $500 tool when their cell phone with a free app can do the same thing at no cost.
    Politicians should listen to the public — not the lobyists

  13. I looked up which Congressional committees have Medicare oversight responsibility, and only came up with one:
    https://www.finance.senate.gov/
    Contacting your own two Senators, AND the “Ranking Minority Member”, Ron Wyden of Oregon might be a good place to start. If one of your Senators is on the Finance committee, it might even carry a bit more weight.

    As incensed as one might be about the subject (like me), a relatively short AND respectful (choke…) e-mail or letter, outlining the issue and arguments against this short-sighted (and yes, f–king stupid) rule would be more effective than the sort of rant most of us (like me) would probably rather deliver. There are plenty of good points to make, many from within this series of posts!

    Do your Senators ever do “town hall” type events in your area? If you have an opportunity for direct contact with your Senator(s), meet with them or their aides – human faces and personal stories tend to make an issue more real for them. Even more-so if you can get a group of PWDs together for the event.

  14. I am a new recipient of the Dexcom 5 & bought a new iWatch in anticipation of being able to monitor my glucose while driving, playing guitar on stage, working in the yard or hiking by simply glancing at my wrist watch.
    Now I’ve found that this is PROHIBITED!
    Wouldn’t everyone be safer if they didn’t have to pull out their device while driving?
    Don’t you want my wife to be alerted if I have low glucose in the middle of the night?
    She’s only literally “saved my life” about 10 times.
    What could be the possible downside to allowing this?
    I’ve been Type 1 since age 31 & I’m now 69!
    I believe that together we can get this absurd rule reversed.
    Tell us where to send our letters & we will flood them with out logic & safety concerns.

  15. Typo correction on last line.

    Tell us where to send our letters & we will flood them with our logic & safety concerns.

  16. Is there really no web site I can use to share with my dr and look at last weeks grafts to compare them

  17. Is there no website to share results with drs and so I can look up last weeks grafts

  18. This is a great atrocity. My son was diagnosed last year with T1D at the very young age of 1.5. We acquired both the Omnipod and Dexcom systems for him, and, due to their technological advances, my wife and I are extremely grateful. Up until last fall (maybe later) we were using the Dexcom apps to keep us informed of his BG levels, no matter where we were. After the fall, we discovered no matter what we did, we couldn’t get the apps to sync with any of our devices. It didn’t take long to discover why. Medicare!!!! Why in the world would you take away a great freedom that Dexcom and smartphones are providing us?? My wife and I live in New Hampshire. Our Senator has a relative with diabetes, so, when we write to her, if she doesn’t know about this already, will hopefully look into it, and do her best to rectify this great travesty. As for the rest of you with T1D, and your families, please, please do your best to contact your congressman, and senators, to complain about this Medicare selfishness….

  19. For those of you who have not already heard this. there is a hopeful announcement from CMS that its policy prohibiting use of the Dexcom CGM with its compatible smartphone features is about to change:

    https://www.cms.gov/Center/Provider-Type/Durable-Medical-Equipment-DME-Center.html

  20. It’s official! If you’re on Medicare and use a CGM, you can now use your smartphone with it. A very informative article with all the details can be found here:

    https://diatribe.org/medicare-now-allows-cgm-use-smartphone-apps-including-sharing-features

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