CMS Changes Coverage for CGM Devices

A longstanding four times per day testing requirement will cease, and patients using inhaled insulin now qualify for continuous glucose monitoring.

CMS has updated is coverage of continuous glucose monitoring (CGM) devices. Effective July 18, 2021, the update eliminates the four times per day testing requirement to qualify for a CGM device and allows for patients using multiple daily administrations (updated from injections) of any insulin, which helps to provide a coverage pathway for people using inhaled insulins.

“After years of advocacy from the diabetes community and the [Association of Diabetes Care and Education Specialists], Medicare has taken an important step to make continuous glucose monitoring more accessible for Medicare beneficiaries with diabetes. This updated coverage determination was a direct result of coordinated advocacy efforts among patient and provider groups, as well as industry partners, coalitions and other entities,” Kate Thomas, chief advocacy and external affairs officer of the ADCES, said in a blog post.

Long the standard of care in type 1 diabetes, CGM has been found in a recent study to result in better glycemia control compared with blood glucose meter monitoring in adults with poorly controlled type 2 diabetes (T2D). In this study, published June 2, 2021, investigators found that in a randomized clinical trial including 175 adults with T2D, there was a decrease in glycated hemoglobin (A1C) level over eight months with CGM.

In another study published June 2, 2021, investigators also found CGM was associated with better glycemic control and lower rates of hypoglycemia. This was a retrospective study of 41,753 insulin-treated patients with diabetes selected by physicians for real-time CGM had significant improvements in A1C and reductions in emergency department visits and hospitalizations for hypoglycemia.

Last year, a study among adolescents also found an improvement in glycemic control over 26 weeks.