After temporarily revising CGM eligibility guidelines during the COVID-19 pandemic, CMS recently made a permanent change that will increase access to CGMs for people with diabetes over age 65.
The Centers for Medicare and Medicaid Services (CMS) recently announced updated CGM eligibility guidelines that will permanently make CGMs more accessible for people with diabetes on Medicare. This is an important step towards equitable care for people with diabetes.
Beginning July 18, Medicare will no longer require beneficiaries to perform four daily blood glucose tests to qualify for a CGM. This removes a cost barrier to CGMs because while CMS required four daily blood glucose tests, Medicare covers only three test strips a day - forcing people to pay out-of-pocket for more test strips that they are not reimbursed for.
CMS also adjusted its CGM eligibility requirement on insulin dependence. Originally requiring individuals to use three or more multiple daily injections of insulin, CMS changed the wording to three or more daily “administrations.” This update will increase access to CGM for people who use inhaled insulin.
With these updates, the following will be the Medicare CGM eligibility requirements starting July 18:
- You have diagnosed diabetes.
- You are treated with insulin either through three or more daily insulin administrations or through an insulin pump.
- Your insulin dosing requires “frequent adjustment” based on BGM or CGM testing results.
- You meet with your healthcare provider in-person within 6 months prior to ordering the CGM to assess diabetes control and your eligibility for the device.
- You meet with your healthcare provider in-person every 6 months after you are prescribed a CGM to assess your experience with the device.
Why is this important?
CGMs have proven to help people with diabetes improve their Time in Range, A1C, and long term health outcomes. CGMs can also improve quality of life by removing the need for finger sticks and giving people with diabetes real-time health data to inform their daily management. Despite the proven benefits of CGM use, too few people with diabetes have access to these devices. Only 1 in 4 people with insulin dependent diabetes have a CGM, according to Bigfoot Biomedical.
As of 2016, nearly 1 in 3 Medicare beneficiaries had diabetes or prediabetes, as the Kaiser Family Foundation reports. The prevalence of diabetes among Medicare beneficiaries has likely grown since then, increasing the need for innovative technologies such as CGMs. This is especially important for people on multiple daily injections of insulin who experience worse health outcomes and have higher health costs than non-MDI type 2s. However, there are still major barriers to accessing a CGM on Medicare due to issues of affordability, eligibility, and education.
While these adjustments to the CGM eligibility requirements are promising, more can be done to increase access to CGMs and other technologies for people with diabetes. diaTribe Change believes that CMS should eliminate the requirement for multiple daily insulin adjustments to increase CGM access for more people with type 2 diabetes. Further, the CMS needs to make CGMs more affordable for Medicare beneficiaries to remove cost barriers to these devices.
diaTribe Change applauds these changes by CMS and continues to advocate for increased access to CGM for all people with diabetes.