Medicare Loosens Restrictions on Continuous Glucose Monitor Coverage
Medicare revised its local coverage determination (LCD) policy, to take effect on July 17, 2021, on continuous glucose monitors (CGMs) to remove arduous requirements, making CGMs more accessible for people with diabetes. Originally, the Medicare statute required patients with diabetes to attend in-person clinical visits and use a fingerstick four times a day in order to prove their diabetes management status to qualify for a CGM. Medicare announced that they will no longer enforce the aforementioned requirements for continuous glucose monitor coverage.
Under Medicare, CGMs are covered under the durable medical equipment (DME) benefit. In order for a beneficiary to be eligible for reimbursement for a CGM, they must meet the aforementioned requirements. However, these rules can become hurdles to accessing CGMs. Rodolfo Galindo, MD, FACE, an endocrinologist based in Atlanta, says that the utilization of a benchmark for a certain amount of fingersticks per day has no medically sound reason for its usage, as it showed no association with HbA1c reductions. In addition, due to some patients’ limited dexterity, frequent fingersticks can become a less viable option.
Coupled with physical limitations, requiring a baseline number of fingersticks to prove CGM need becomes a financial concern, especially for low-income populations. Under the previous Medicare rules, patients with diabetes had to test their blood glucose levels using four strips daily, despite only being provided insurance coverage for three strips per day. Test strips can be costly at around 100 dollars and more each month. This puts an undue financial burden on Medicare beneficiaries, many of whom are already below the federal poverty line.
The requirements have also directly impacted healthcare providers. The former process of obtaining CGMs was cumbersome, involving in-person visits, lab tests, documentation of four tests per day and paperwork. The uplift will allow healthcare providers to recommend CGMs more seamlessly without the need for bureaucracy and paperwork. In-person clinical visits requirements and mandatory lab tests were loosened during the Trump Administration due to the increased risk that COVID-19 posed for people with diabetes.
There have been many known benefits for CGM usage including significant reductions in HbA1c levels, increase in time in range and reductions in diabetes-related hospitalizations. Changing the LCD policy will mean that people with diabetes will not have to undergo lab tests or visit a physician in order to qualify for a CGM, eliminating barriers to already often inaccessible diabetes technology.