Continuous Glucose Monitors Universal Utilization Principles
Legislators and policy makers can support measures that will ensure those who can benefit from continuous glucose monitors (CGM) have access to the devices.
- Ensuring CGM coverage for adults and children with diabetes who use insulin
- Eliminating burdensome requirements and barriers to access, such as:
- Requiring beneficiaries to use a blood glucose monitor to test multiple times per day to be eligible for CGM.
- Requiring a minimum number of daily insulin injections.
- Requiring prior authorization, like step therapy.
- Devising a clear and timely appeals process for denials of coverage.
- Making CGMs available through as many channels as possible, including both mail-order and local pharmacies.
- Allowing broader prescribing authority to include not just endocrinologists, but other health care providers with CGM experience.
- Ensure patient and provider-centered choices for CGM, such as:
- Choosing technology that is individualized based on patient’s needs, requirements, skill level, and availability of devices.
- Avoiding interruption in access that may result from the need for new training and education or lack of supplies and equipment.
- Adopting a transition period coupled with an exceptions process, enabling beneficiaries successfully using a CGM to continue to use it and its associated supplies regardless of new limitations or exclusions.
March 2, 2023: Centers for Medicare and Medicaid Services (CMS) Announce Expanded Continuous Glucose Monitor (CGM) Coverage.
CMS announced expanded coverage of continuous glucose monitors (CGMs) to include all insulin-dependent people and those with a history of problematic hypoglycemia.
“The American Diabetes Association (ADA) has been a leader in advocating for broader access to important diabetes technology for all people living with diabetes. We applaud CMS’ decision allowing for all insulin-dependent people as well as others who have a history of problematic hypoglycemia to have access to a continuous glucose monitor, a potentially life-saving tool for diabetes management,” said Chuck Henderson, Chief Executive Officer, American Diabetes Association. “Making this resource more widely available is a critical objective of the ADA's Technology Access Project, and we will continue to press for policies that ensure all people with diabetes, especially those who are under-resourced, have access to life-saving technologies.”
See our frequently asked questions for additional information on this change and review below for more information on continuous glucose monitors.
You Can Help
To learn more about how you can improve the lives of people with diabetes by supporting increased access to CGM, please provide your contact information below.