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CGM Reimbursement

Published: 4/30/09

If you’re a regular diaTribe reader, you probably know that we’re big fans of Continuous Glucose Monitoring (CGM)—devices that let you see your glucose levels in real-time and watch whether they’re going up, down, or remaining steady. We think that these devices can help people with type 1 and type 2 diabetes improve blood glucose control – even if it already appears to be really good!

However, truth be told, these are expensive devices and few people can afford to pay for them out-of-pocket. We thought it would be helpful to publish a list of insurance companies that have begun to offer favorable CGM coverage. Here’s the list, according to the Juvenile Diabetes Research Foundation (JDRF), strong proponents of CGM technology:

  • Aetna—Will cover CGM for all patients with type 1 diabetes over age 25 or under 25 with severe hypoglycemia

  • CIGNA—Will cover CGM for patients with type 1 diabetes with severe hypoglycemia AND for type 2 patients with recurrent severe hypoglycemia who meet a specific c-peptide threshold (talk to your doctor)

  • Highmark Blue Cross Blue Shield and Humana—Will cover for type 1 patients with severe hypoglycemia or hypoglycemia unawareness (if you don’t notice when your blood sugar is severely low)

  • Kaiser Permanente in CA—Will cover for all patients with type 1 diabetes who meet specific Kaiser coverage criteria

  • United HealthCare—Will cover patients with type 1 diabetes who have not achieved optimum control (most people are probably eligible)

  • Wellpoint/Anthem—Will cover patients with severe hypoglycemia or those who are pregnant

If your insurance company is on this list and you meet the criteria, you should ask your doctor about CGM, particularly if you have hypoglycemia unawareness or frequently unpredictable glucose levels. If your insurance company is not on the list, they should be, in our view, and the pressure is on, as all the big five “heavyweights” have approved CGM in some way. Now, there’s one clear thing missing – most of this coverage is for type 1, even though we’ve heard from a number of type 2 patients that CGM may be helpful for them as well. The reason coverage is more limited for type 2 patients is because not enough studies have been done, and the benefits of CGM in type 2s are not as certain. We think there’s a clear message to companies – please do some more type 2 studies to find out if CGM can be beneficial!. In the meantime, a growing number of healthcare providers are offering CGM rentals for their type 2 patients. This makes great sense to us. If your A1c is over 7%, it might really help you to get into better control, and even if you don’t have a high A1c, it might help you avoid serious highs and lows. For type 2s who have never tried CGM, we might recommend a physician-based system first - we will be writing about this more in diaTribe #16. If CGM isn’t available, of course, you can get some of this information from a few days of taking 12-24 fingersticks every day, but CGM might be a better bet – ask them and ask them again!

By the way, the JDRF is a great resource to find out if your insurance company covers CGM, even if it’s not on the list above.

We think it’s important to get the word out about this technology so that it can benefit the greatest number of people possible. We really appreciate the work of the JDRF, which has done critical research to help persuade insurance companies to cover CGM devices. You can also visit the Children With Diabetes Insurance forum and join discussions or learn about what strategies have worked well for others.

What do you think?