Continuous Glucose Monitors
March 2, 2023: Centers for Medicare and Medicaid Services (CMS) Announce Expanded Continuous Glucose Monitor (CGM) Coverage.
“The American Diabetes Association (ADA) has been a leader in advocating for broader access to important diabetes technology for all people living with diabetes. 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,” said Chuck Henderson, Chief Executive Officer, American Diabetes Association. “Making this resource more widely available is a critical objective of the ADA's Technology Access Project, and we will continue to press for policies that ensure all people with diabetes, especially those who are under-resourced, have access to life-saving technologies.”
See below for more information on continuous glucose monitors.
“These are devices that can help people without much more engagement than turning on and looking at their phone." –Dr. Anastasia Albanese-O’Neill
“With patients, if they can actually see what their numbers are they will make different choices.” –Tandalaya Traylor, CGM provider
“I’ve had my A1Cs drop from 13% to 8% with folks using CGM because they’re getting that real-time information.” –Dr. Sara Reece, CGM provider
Advances in Continuous Glucose Monitor (CGM) technology have made our lives easier, and that goes for people with diabetes as well. Insulin administration and blood glucose (blood sugar) monitoring have transformed from multiple finger pricks in a day to a few swipes on a cell phone. With a continuous glucose monitor (CGM), one can see in real time if they’re trending high or low and take preventative measures against hypo and hyperglycemia. Real time CGM monitoring has led to tremendous outcomes for people with diabetes who, without a CGM, may have experienced potentially life-threatening complications.
With the benefits and ease of use that a CGM provides, it would be natural to assume everyone with diabetes has one, or at least has access to one. That however is not the case, studies show that poorer, older, Black and Brown Americans and Americans on Medicaid have less access to CGMs than their counterparts. This is a health disparity we can’t ignore. People with diabetes have the right to access the latest technologies. Federal and state government officials can and should take steps to drive improved and more uniform coverage policies for diabetes technology and supplies within.
What is a CGM?
CGMs continually monitor your blood glucose (blood sugar), giving you real-time updates through a device that is attached to your body. They have become popular and more accurate over the years and are now considered a viable treatment option for people with diabetes.
Why are CGMs Beneficial?
CGMs provide significant, potentially life changing benefits for diabetes management. CGMs are recommended for several reasons because they:
- Help avoid or delay serious, short- and long-term diabetes complications.
- Potentially save money through improved diabetes management and fewer events, like hypoglycemia (low blood glucose) leading to emergencies.
- Offer people with diabetes and their health care team more details about glucose levels than traditional blood glucose meters—giving the opportunity to analyze the data more precisely than ever before.
- Provide biofeedback in real time, which allows people with diabetes to modify their dietary pattern or insulin dose based on trends, as directed by their health care provider. This may reduce your risk of hypoglycemia and hyperglycemia (high blood glucose).
People with type 1 and type 2 diabetes who use a CGM have fewer instances of hypoglycemia and a lower A1C.
Obstacles to access CGMs
One obstacle with CGMs is the cost of access to diabetes technology. Many people with diabetes who have put off getting an insulin pump or CGM, do so because they are too expensive.
Another major obstacle is due to strict Medicaid coverage policies they are not accessible for people who need them. In fact, people with diabetes on Medicaid, especially in minority communities who use Medicaid, are the least likely to use a CGM.
This is concerning since people with diabetes are more than twice as likely to receive their health care from Medicaid as those without diabetes.
Individuals who meet the coverage criteria listed in the FAQs below for a CGM and want to learn more about them should talk to their health care provider to ensure it is the right tool for the management of their diabetes.
FAQs on CGM Coverage Criteria Changes in Medicare
If you or your patients have Medicare, new changes allow greater access to a CGM devices. Medicare beneficiaries with diabetes may be eligible if they:
- Have diabetes
- Your health care provider concludes you (or your caregiver) have sufficient training using the CGM prescribed as evidenced by providing a prescription
- The CGM is prescribed in accordance with its Food and Drug Administration (FDA) indications for use
- The beneficiary for whom a CGM is being prescribed to improve glycemic management meets at least one of the criteria below:
A. Is insulin-treated
B. Has a history of problematic hypoglycemia (low blood glucose, also called low blood sugar) with documentation of at least one of the following:
—Recurrent (more than one) level 2 hypoglycemic events (glucose <54mg/dL (3.0mmol/L)) that persist despite multiple attempts to adjust medication(s) and/or modify the diabetes treatment plan
—A history of one level 3 hypoglycemic event (glucose <54mg/dL (3.0mmol/L)) characterized by altered mental and/or physical state requiring third-party assistance for treatment of hypoglycemia.
- Within six months prior to ordering the CGM, the treating practitioner has an in-person or Medicare-approved telehealth visit with you to evaluate your diabetes control and determine that criteria one through four above are being met.
- Medicare now allows people to receive a CGM if they are treated with insulin—any type and any amount. (The CMS previously required people with diabetes to take a certain amount of insulin per day to access a CGM.)
- Medicare now allows individuals with diabetes who do not take insulin to receive a CGM if they have a history of problematic hypoglycemia.
- Within six months of ordering a CGM, a person must have an appointment with their provider. That appointment may now either be in person or via telehealth.
This is effective as of April 16, 2023.
There are no requirements as to the type of insulin you take or how much, you just need to be prescribed insulin as a form of treatment for your diabetes.
It does not matter what type of diabetes you have, just as long as you have a diabetes diagnosis and are taking insulin.
No. The CMS will cover your CGM device as long as it is FDA-approved.
You can find more information on this specific change on the CMS website and on this webpage.
We recommend you begin by speaking to your health care provider to see if using a CGM is a good option for you.
Health Equity and Diabetes Technology: A Study of Access to Continuous Glucose Monitors by Payer, Geography and Race Executive Summary
The American Diabetes Association® (ADA) released a new study looking at pharmacy and medical benefit claims for CGMs across commercial insurance plans, Medicare and Medicaid and data on age, race, geography, and diabetes prevalence. The findings show people of lower income and older people of color who live in states with the highest rates of diabetes prevalence and mortality are the least likely to get access to a CGM. ADA is quite concerned about these findings, given the effect of the COVID-19 pandemic on this population and the importance of tools like CGMs in diabetes management.
The ADA is addressing the issue. We are partnering with people with diabetes, health care professionals, advocacy groups, and policy makers to address CGM access for those who use Medicaid. We’re advocating for CGM coverage and working to get rid of barriers to necessary diabetes technology so people can better manage their diabetes and experience fewer poor health outcomes and premature deaths.
You Can Help
We need your help in eliminating these systemic barriers to CGMs! Soon, there will be an opportunity to get involved (depending on your state) with CGM Medicaid regulations and increased access to this technology.
If you are interested in providing comments and having your voice heard on behalf of people with diabetes, please provide your contact information below.
Continuous Glucose Monitor (CGM) Studies
- Health Equity and Diabetes Technology: A Study of Access to Continuous Glucose Monitors (PDF)
- Continuous Glucose Monitoring: A Review of Recent Studies Demonstrating Improved Glycemic Outcomes
- Medtronic Case Studies: Real Patient Experiences
- Glycemic Outcomes in Adults With Type 2 Diabetes Participating in a Continuous Glucose Monitor-Driven Virtual Diabetes Clinic: Prospective Trial
- Rapid Adoption of Telemedicine Along with Emergent Use of Continuous Glucose Monitors in the Ambulatory Care of Young Persons with New-Onset Type 1 Diabetes in the Time of COVID-19: A Case Series
- Acceptability and Utilization of Newer Technologies and Effects on Glycemic Control in Type 2 Diabetes: Lessons Learned from Lockdown
- Glycemic Outcomes in Adults With Type 2 Diabetes Participating in a Continuous Glucose Monitor–Driven Virtual Diabetes Clinic: Prospective Trial
Continuous Glucose Monitor (CGM) Articles
- Continuous Glucose Monitoring Improves Glycemic Outcomes in Children with Type 1 Diabetes: Real-World Data From a Population-Based Clinic
- Effects of Continuous Glucose Monitoring on Metrics of Glycemic Control in Diabetes: A Systematic Review With Meta-analysis of Randomized Controlled Trials
- Real-World Studies Support Use of Continuous Glucose Monitoring in Type 1 and Type 2 Diabetes Independently of Treatment Regimen
- Barriers to Uptake of Insulin Technologies and Novel Solutions
- The Effectiveness of Continuous Subcutaneous Insulin Pumps with Continuous Glucose Monitoring in Outpatient Adolescents with Type 1 Diabetes: A Systematic Review
- Practical Aspects of Diabetes Technology Use: Continuous Glucose Monitors, Insulin Pumps, and Automated Insulin Delivery Systems
- Diabetes Device Use in Adults with Type 1 Diabetes: Barriers to Uptake and Potential Intervention Targets