State Advocacy

June 2023: Medicaid’s revised continuous glucose monitor (CGM) policy goes into effect—expanding coverage to those with type 2 and gestational diabetes—eliminating the requirements for three or more insulin administrations per day, multiple daily blood glucose testing, and frequent adjustment to insulin. It has also eliminated prior authorization for those beneficiaries with type 1 diabetes and gestational diabetes.

May 2023: A bill was signed into law capping copayments for medications needed to treat chronic diseases, including diabetes. The bill caps copayments for prescription medication at $25 per prescription and $50 cumulative for supplies (both for 30-day supplies). 

March 2023: A bill was signed that extends Medicaid coverage to 12 months postpartum.

• May 2023: A bill was signed into law related to state-regulated health insurance and caps copayments for insulin at $35 per prescription per 30-day supply.
• May 2023: A new law updates state-regulated health insurance coverage for diabetes self-management education and support (DSMES) services, aligning the coverage with current standards of care. Under the new law, people will have access to up to 20 visits of DSMES services in the first year and 12 follow-up visits in subsequent years.

• January 2023: The finalized Medicaid continuous glucose monitor (CGM) policy includes coverage for all types of diabetes when medical necessity criteria is met. The policy also makes CGMs available through both the pharmacy and medical benefit, further improving access.
• June 2023: A bill was signed into law to cap cost-sharing for insulin at $35 per 30-day supply for state employees and those in state-regulated health plans.
• June 2023: A bill was signed to require the submission of a state plan amendment to extend postpartum Medicaid coverage from 60 days to at least six months (with the authority to submit a SPA for 12 months).

July 2023: New Jersey has become the 25th state (as well as the District of Columbia) to cap out-of-pocket costs for insulin at $35 per 30-day supply for state-regulated health plans (and includes public employee health plans as well).

March 2023: North Carolina became the 40th state to expand Medicaid. Once implemented, the expansion is expected to provide insurance for over 600,000 North Carolinians. 

April 2023: North Dakota passed legislation to cap copayments for the public employee health plan. The law created a $25 insulin copay cap and $25 cumulative copayment cap for supplies (both for 30-day supplies). 

July 2023: The Ohio budget contains a provision whereby all students who qualify for reduced-priced meals will be eligible for free meals (both breakfast and lunch).

• April 2023: A bill was signed improving consumer protections related to step therapy protocols used by health plans.
• May 2023: A bill was signed that allows for undesignated glucagon to be prescribed in the school setting to help ensure backup glucagon is available.

April 2023: Passage of the state budget will result in TennCare (Medicaid) beginning to offer coverage for continuous glucose monitors (CGMs) (both through the pharmacy and DME benefit) effective July 1, 2023, improving ease of access.

March 2023: A law was passed that allows pharmacists to refill prescriptions for insulin in an emergency without updated authorization from the current prescriber. 

May 2023: A law was passed that removes the January 1, 2024 expiration date for the state’s $35 insulin copay cap. 

• March 2023: The budget includes $97,125 in funding for diabetes education and prevention programs.
• March 2023: A bill was signed into law related to state-regulated health insurance plans. The law will reduce cost-sharing on insulin from $100 to $35 for a 30-day supply and set a similar, collective cost-sharing limit of $100 on continuous glucose monitors (CGMs), blood glucose test strips, glucometers, lancets, lancing devices, and insulin syringes.

February 2023: A bill was signed into law to add Medicaid coverage for podiatry services.