Every so often, what starts out as a simple frustration in ordering medical supplies reveals a specific flaw in the process, that can just maybe lead to a fix that helps the broader community.
That appears to be what happened with my recent order for a new Dexcom G5 CGM (continuous glucose monitoring) system, and I'm happy to have seemingly exposed a metaphoric monkey wrench in how third-party suppliers handle orders for this D-tech.
I hate to tell you, Folks, but as diabetes technology gets more sophisticated and remote software updating becomes part of the equation, it's only getting harder to interact with your insurance company and third-party medical suppliers on what you need!
Here's how it went down for me...
My Third-Party Supplier Snafu
It began in early December, when it was time to get a new transmitter for my CGM system.
The one I'm using still has juice in it, but I am diligent about ordering close to the time the warranty expires so that I've always got another on hand when the current transmitter battery croaks.
I decided to switch from a Dexcom G4 to the G5 Mobile System. I'd resisted doing this earlier, mostly because it was initially iPhone-only and I'm an Android guy, but also because I didn't want the shorter transmitter battery life (three months with a hard shutoff, instead of anywhere from 6 months to a year or so). Since the G5's now Android-compatible and we're probably less than a year out from the next-generation CGM sensor, I decided it was time to change over to the G5.
So I got my endo's prescription and Prior Authorization, and called my assigned third-party distributor in Michigan to get the ball rolling. Because I'd obtained a new Bluetooth-enabled Direct with Share receiver in June 2017, I am not eligible to get Dexcom's new touchscreen receiver until next summer once my warranty expires.
So, I just ordered the G5 transmitters.
But my third-party company told me they could not fill my order, because as a DME supplier they must send a receiver at the same time, per the FDA. When I explained that my current in-warranty Share Receiver can be used with G5 transmitters, they said that is not the case.
Ummm.... huh?! Yes, it is possible. That's how the freakin' G5 CGM system has been working since it was approved 2015 -- you know, in the two years before this new touchscreen receiver was even launched!
Pictures speak a thousand words, and I wish this had been a video call or I was standing next to her, so I could have used pictures to illustrate my point:
I want this G5 setup:
Not this one:
But, words were all we had and this supervisor wanted it straight from the horse's mouth -- Dexcom. So she put me on hold while she phoned the CGM company in California.
After the 15 minutes it took for that to occur, she came back and told me she'd asked: "Can a G4 Share receiver work with a G5 transmitter?" The Dexcom representative told her no, that a G4 receiver only works with G4, and G5 works with G5.
As she spoke, I found my head shaking vigorously... I could see how they were talking around each other.
Hello, Medical Firmware Updates
While it wasn't technically inaccurate, the third-party supplier supervisor clearly didn't know the right question to ask and the Dexcom rep didn't think to mention the new firmware update capability.
I tried to explain that this was technically the same receiver device, but it had a firmware update that could change it from G4 to G5; that I didn't need a whole different piece of hardware for this to work. The supply company lady didn't get it.
So once again, we initiated a three-way call with yet another Dexcom rep and she asked the same question: "Can a G4 receiver work with the G5 transmitter?"
His answer: No.
I interjected, politely but firmly pointing to the firmware remote update from the Direct Receiver that would allow me to change it from a G4 to G5 receiver, without a need for them to send me another one. And whala! He agreed and verified this, enlightening the third-party supplier supervisor on the line.
After disconnecting with Dexcom, the supervisor told me that was new information to her and it was something that fundamentally changes how they'll supply Dexcom G5 systems (and probably G6's, in the future) to people going forward. She also mentioned that there were likely other PWDs who'd tried to get the G5, but may have been turned down on the same erroneous grounds.
Yikes! I hate to think that's the case, that people were denied access just because of a misunderstanding in how the technology functions and new updating process works!
A Teaching Moment
During this process that took basically an entire afternoon, I was a bit annoyed but tried not to be angry.
I could see how this could happen...
I suppose it's a real challenge for third-party suppliers to know the ins-and-outs of every single device they distribute, and the nuances of multiple generations of that technology. Plus, with the growth of CGM use in the past couple years and Dexcom's expansion and increased demand via Medicare CGM'ers, it's not surprising that the good customer service folks at Dexcom may not realize how confusing remote updates can be to many third-party suppliers.
Cleary Dexcom has some 'splaining to do to give these vendors a clear understanding of the G4-to-G5 process (and sooner rather than later, the G6 upgrades that'll begin).
It was also interesting to me that a couple times, my third-party supplier rep told me specifically that the Dexcom G5 was not yet FDA-approved for Android; that Dexcom "allowed" it, but regulators hadn't yet given the green light. That is clearly inaccurate, and I made sure to correct them and point to the fact that it's been OK'd by FDA since June 2017.
While I initially thought about changing my mind and sticking with older G4, I'm glad I stood my ground and fought for the G5, and thereby helped to inform the process. This was not a case of insurance trying to tell me something isn't medically necessary when it clearly is, but rather "growing pains" in how our healthcare system and all its players operate when dealing with new technology tools.
I also expect this exact same issue will surface for many people once the Dexcom G6 is finally launched, and everyone's in need of a completely new sensors and transmitters and may be navigating multiple generations of Dexcom products.
For the record, I did pass the above-story along to Dexcom's leadership and was told they were sharing that up and down the chain to help inform their own process and people, to be aware of these possible scenarios.
This is just one personal example, of course, but I expect many others may be dealing with similar issues.
My new G5 transmitters arrived this past week, just in time to get a place under our Christmas Tree!
While I haven't yet connected to my G5 (as my G4 transmitter is still going after eight months), I am happy to know that these two new G5 transmitters are are ready to go, along with a stocking full of CGM sensors :)
Here's to moving on to a new CGM generation, and before long probably doing the same change to a next-gen Dexcom G6 once it's approved and available!