Updated Medicare Guideline for CGMs DECODED

Is this future guideline a true win for all diabetics patients on Medicare?

Last Friday, the American Diabetes Association posted a late night announcement regarding a major change from the Center for Medicare Services regarding the current guidelines for for a continuous glucose monitor

This is the post in it’s entirety:

“Medicare has permanently eliminated the 4 times-a-day testing requirement to qualify for a CGM. This long-time barrier to CGM access will be permanently removed on July 18, 2021! The removal of this criterion has been an effort long-led by the ADA, on which we have been actively engaged with CMS.

PWD on Medicare will now be able to more easily access this critical piece of technology, leading to better diabetes management and better health outcomes. A big win for the diabetes community!”

It definitely sounds like fantastic news for diabetic patients! But what does it mean diabetic patients on Medicare can now go to their nearest pharmacy and get that CGM, right?

Not so fast.

While talking with a fellow diabetic support friend later that night, he enlightened me that this news is only one piece of a large puzzle.

Take a look at the following snapshot of the future CGM qualification guidelines below:

According to the future guidelines, even though the 4 times a day blood glucose monitoring will no longer be valid, the patient will still need to “be insulin treated with multiple daily administrations of insulin or a continuous subcutaneous insulin infusion pump.”

In short, in order for a diabetic patient on Medicare to qualify for a CGM, the patient not only has to be insulin-dependent, but the patient will have to take insulin three or more times a day.

This is not a win for all type 2 diabetics. As my friend expressed, the new guideline places a huge barrier for type 2 diabetics who are non-insulin dependent. Unfortunately, if you are a type 2 diabetic on Medicare, you will not qualify for a continuous glucose monitor.

There’s still a ton of work to be done in order for all diabetic patients can have equal access to the medicine and equipment without going through hoops and loops. This is a step in the right direction, and,for what it’s worth, this small step is still worth celebrating.

But tomorrow, it’s time your armor and fight again.

Until Next Time,

The Genetic Diabetic

The full local coverage determination (LCD) may be found here: https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?lcdid=33822&ver=31&fbclid=IwAR3SQBavug1kcfeOVwwxuWUalWHmd_wmqFPDqWaDwyVAO81BuyYzN77Rxi0

4 thoughts on “Updated Medicare Guideline for CGMs DECODED

  1. I’m left wondering who exactly determines this criteria, what statistical data they go by and more importantly, if they survey actual PWD (type 1 and 2) about better outcomes using CGM’s. I would think that by now there’s enough medical evidence to prove CGM’s for both types is beneficial and helps prevent future complications which equals more cost in the long run to the healthcare industry. Grrrrrr…..

    1. And what’s crazy is that the companies making the CGMs want to market the product to type 2 diabetics because more there are significantly more type 2 diabetics ($). However, I’ve heard a few studies claim that CGM does not have a significant impact among non-insulin dependents. Unfortunately, I believe that those particular studies are impacting these decisions. It’s very frustrating because this should be available for all diabetics.

  2. I agree. I think CGM’s would help anyone with diabetes to understand the concept of “time in range”, how to achieve it and the benefits of learning how what you eat affects your BG levels over a longer period of time than finger sticks.

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