Medicare to Expand CGM Coverage for People with Type 2 Diabetes
By Susannah Chen
Medicare will begin covering continuous glucose monitors (CGMs) for a broader group of T2D patients beginning in April.
The Centers for Medicare and Medicaid Services (CMS) announced on March 2 an updated policy effective April 16 that will expand continuous glucose monitor coverage to more people with type 2 diabetes.
The expanded coverage of the new policy will apply to insulin-treated individuals with diabetes who have traditional Medicare coverage (not Medicare Advantage), as well as certain non-insulin-using individuals who have a history of what has been classified as “problematic hypoglycemia.”
“There are millions of people with type 2 diabetes using basal insulin who now will be eligible for CGM coverage, either through Medicare or private insurers who are likely to follow the CMS determination,” said Dr. Roy Beck, medical director at the Jaeb Center for Health, adding, “A positive offshoot of this will be that primary care providers will become more experienced with CGM since most people with type 2 diabetes treated with basal without bolus insulin are followed in a primary care setting.”
“As CGM has become smaller and easier to use, I am thrilled that the access is expanding. The evidence is clearly there on the benefits of CGM in achieving target glucose levels and improving quality of life,” Dr. Diana Isaacs, clinical pharmacist and diabetes care and education specialist at the Cleveland Clinic, said, adding: "This is a major win for people with diabetes."
Traditional Medicare claims are processed through local entities called Medicare Administrative Contractors (MACs), private healthcare insurers permitted to process Medicare claims who decide coverage and payment policies for a range of services, and medical equipment, including CGMs. A group of MACS initially proposed a new policy to expand coverage to include CGMs last October.
The diaTribe Foundation, through the Time in Range Coalition (TIRC), submitted a comment letter to express support for the proposal. The comment letter highlighted the importance of the proposed coverage policy change because it would help expand access to care, advance equity, reduce disparities, and decrease health care costs.
The letter also thanked the MACs for recognizing the racial, income, and geographic disparities that exist within the diabetes community and in accessing CGMs.
In response, the MAC Directors expressed their thanks for the feedback and said they “are hopeful that the finalized … [policy] will help decrease health disparities in the diabetes community.”
A decision was expected later this year and the final determination was heralded by advocates across the country. Some equity research analysts have speculated that this decision increases access for approximately 1.5 million people with diabetes in America who currently use basal insulin treatment covered by Medicare.
