Continuous glucose monitors (CGMs) may soon be eligible for coverage by the US Centers for Medicare and Medicaid Services (CMS).
Continuous glucose monitors (CGMs) may soon be eligible for coverage by the US Centers for Medicare and Medicaid Services (CMS). The CMS has recognized CGMs approved by the FDA for use in making diabetes treatment decisions as “durable equipment,” according to the Juvenile Diabetes Research Foundation (JDRF) press release.
Advocacy efforts have targeted CGM recognition for years, and the recent stamp of approval from CMS marks a step closer to Medicare coverage of these medical devices. Most private US insurers cover personal-use CGMs for patients with diabetes, but Medicare and Medicaid have not, despite CGM’s presence in diabetes treatment for over a decade. Now that CGM devices have been determined as “durable medical equipment,” they can now be covered under the insurer on a case-by-case basis.
CGMs are FDA approved and recommended for use by national diabetes clinical guidelines. Clinical evidence highlights significant improvement in diabetes management attributed to CGM use, JDRF notes in their press release. The devices help patients manage their blood sugar and insulin dosing, and are particularly beneficial for seniors with diabetes who are at a high risk for hypoglycemia.
Despite evidence of treatment benefits, CMS has avoided covering the devices under Medicare, stating that CGMs did not meet statutory definitions of durable medical equipment. Patients with diabetes covered under Medicare were required to pay out-of-pocket for the devices, or otherwise go without them.
JDRF states that it will continue to work with CMS officials to provide robust coverage of CGMs for individuals with diabetes on Medicare.
JDRF Encouraged by Medicare Decision to Take First Step Toward Coverage of Continuous Glucose Monitors for People with Type 1 Diabetes [news release]. New York. JDRF website. http://www.jdrf.org/press-releases/jdrf-encouraged-by-medicare-decision-to-take-first-step-toward-coverage-of-continuous-glucose-monitors-for-people-with-type-1-diabetes/. Accessed Jan. 13, 2017.