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

Huge Win for the US Diabetes Community!

If you’re a diabetic on Medicare, then this news is for you!

This story just popped up on my Facebook newsfeed and I’ve decided to do a quick blog post about the announcement. I will discuss this further next week! The following comes directly from the Center of Medicare Services:

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!”

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

Until Next Time,

The Genetic Diabetic

Sound Off: Most U.S. Adults With Diabetes Are Not Getting ADA Recommended Care

Are you following the American Diabetes Association’s recommended care?

A new analyst published by the journal, Diabetes Care stated that most adults are not receiving the care recommended by the American Diabetes Association. 4,069 Adults participated in the National Health and Nutrition Examination Survey between 2005 and 2018. The participants were asked if they had met each of the five main ADA recommendations for diabetes care in the last year — having one or more visits with a primary doctor for diabetes, testing for A1C, an eye and foot examination and cholesterol testing.

In 2015, only 25.0% of participants reported meeting all five of the ADA’s recommendations. However, 34.1% in the 2017-2018 survey reported now meeting all 5 of the ADA’s recommendations. The results showed that older participants (ages 65+) were more likely to report receiving the recommended care for diabetes. There was a slight increase of reports from participants in the 40-64 age group receiving recommended care. However, there were not enough responses in the 20-39 age group to explain an increase in receiving recommended care. All three age groups reported high on receiving A1C testing (From 64.4% to 85.3%).

The study concluded that people who reported not receiving ADA-recommended care were more likely to be younger, have a lower income and wealth, lack health insurance, recently diagnosed with diabetes, not take any diabetes medication, and not have high cholesterol.

Of the people who received ADA-recommended care:

52% more likely to have an A1C level below 7.5%,
47% more than likely to have blood pressure below 140/90 mm Hg
47% more to have LDL (low-density lipoprotein, or “bad”) cholesterol below 100 mg/dl
79% more likely to take a cholesterol-lowering medication

Are you currently following the American Diabetes Association’s recommended care for diabetes? If you’re currently not following these guidelines, are you considering setting up appointments to get your A1C, eyes, feet and cholesterol checked? Let’s have a conversation and learn from each other.

To read the analyst in it’s entirety, click here: https://care.diabetesjournals.org/content/early/2021/04/16/dc20-2541

Until Next Time,

The Genetic Diabetic