Perspectives on Diabetes Care

Medicare Updates CGM Benefit

Jun 14, 2021, 17:19 PM

By Kate Thomas, ADCES Chief Advocacy and External Affairs Officer

After years of advocacy from the diabetes community and ADCES, Medicare has taken an important step to make continuous glucose monitoring (CGM) more accessible for Medicare beneficiaries with diabetes. The Medicare Administrative Contractors (MACs) who oversee the policies for durable medical equipment recently released update clinical coverage criteria for CGM devices. This updated criteria takes effect on July 18, 2021 and includes the following:

• Eliminates the four times per day testing requirement to qualify for a CGM device.
• Allows for individuals using multiple daily administrations (updated from injections) of any insulin, which helps to provide a coverage pathway for people using inhaled insulins.

I want to say a word of thanks to the ADCES advocates who took action on this issue and worked with ADCES to advocate that CMS improve the existing CGM coverage criteria. This updated LCD was a direct result of coordinated advocacy efforts among patient and provider groups, as well as industry partners, coalitions and other entities. Here are ADCES' recent comments to the DME MACs regarding this policy.

Our work is not done. We know there are more changes that must be made and ADCES is working with the Diabetes Technology Access Coalition (DTAC)* to push for additional improvements, including removing the requirement for multiple daily injections of insulin to qualify for a CGM device.

*The DTAC is a multi-stakeholder group dedicated to ensuring the millions of Americans with diabetes have access to the technology they need to manage their diabetes. This group is comprised of provider groups, including ADCES, patient groups, and industry partners.