Medicare Expands CGM Coverage to More With Type 2 Diabetes

Medicare is now covering continuous glucose monitoring (CGM) for all beneficiaries with diabetes who use insulin, as well as those with a "history of problematic hypoglycemia."

The new policy decision, announced earlier this year by the Centers for Medicare and Medicaid Services, means that coverage is expanded to those who take even just a single dose of basal insulin daily or who don't take insulin but who for other reasons experience "problematic" hypoglycemia, defined as a history of more than one level 2 event (glucose < 54 mg/dL) or at least one level 3 event (< 54 mg/dL requiring assistance).

Previously, coverage was limited to those taking frequent daily insulin doses.  

The additional number of people covered, most with type 2 diabetes, is estimated to be at least 1.5 million. That number could more than double if private insurers follow suit, reported an industry analyst.

Chuck Henderson, chief executive officer of the American Diabetes Association, said in a statement: "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."

According to Dexcom, which manufacturers the G6 and the recently approved G7 CGMs, the decision was based in part on their MOBILE study. The trial demonstrated the benefit of CGM in people with type 2 diabetes who use only basal insulin or have a history of problematic hypoglycemic events.

On April 14, Abbott, which manufactures the Freestyle Libre 2 and the recently approved Libre 3, received clearance from the US Food and Drug Administration for the Libre 3's stand-alone reader device. Previously, the Libre 3 had only been approved for use with a smartphone app. The small handheld reader is considered durable medical equipment, making it eligible for Medicare coverage. Abbott is "working on having the FreeStyle Libre 3 system available to Medicare beneficiaries," the company said in a statement.

Miriam E. Tucker is a freelance journalist based in the Washington, DC, area. She is a regular contributor to Medscape, with other work appearing in The Washington Post, NPR's Shots blog, and Diabetes Forecast magazine. She is on Twitter: @MiriamETucker.

For more diabetes and endocrinology news, follow us on Twitter and Facebook.

Medscape Medical News © 2023 WebMD, LLC

Send comments and news tips to news@medscape.net.

Cite this: Medicare Expands CGM Coverage to More With Type 2 Diabetes - Medscape - Apr 17, 2023.