The Centers for Medicare and Medicaid Services (CMS), the federal government agency that administers Medicare for over 65 million Americans, announced an expansion of their coverage for continuous glucose monitor (CGM) systems on Monday, April 17, 2023.
What Medicare’s coverage expansion will cover
This coverage expansion will include individuals with diabetes who’re on any form of insulin, including only a single each day dose of basal insulin, and a few non-insulin-dependent individuals with a history of severe low blood sugar levels.
Medicare previously covered CGMs for individuals with diabetes who received intensive insulin therapy of three or more each day injections. This expansion is a large advocacy win for the diabetes community and is essentially the most significant single expansion of CGM coverage in United States history.
This modification will allow coverage of any CGM brand, including Dexcom.
The MOBILE study
The Dexcom-backed MOBILE study was the first scientific evidence that led to the CMS’s decision. The study showed that using a CGM significantly improves HbA1c levels and increases time in range (TIR), even for adults with type 2 diabetes who only use basal insulin.
Dexcom applauds this decision, stating that the MOBILE study is a component of their ongoing effort to expand access to CGMs to assist people improve their diabetes management and overall quality of life.
Dr. Thomas Martens, key study investigator and internal medicine physician, said, “This can be a major win for the diabetes community and one other validation of how CGMs can profit all people living with diabetes.”
CGMs have proved to bear extensive advantages for individuals with type 1 and kind 2 diabetes who use intensive insulin therapy, but this groundbreaking study reveals that CGMs are useful for people on any type of insulin therapy—not only for individuals who bolus for meals.
Medicare enrollees on basal insulin will even have access to Dexcom’s newest release, the G7—currently essentially the most accurate CGM in the marketplace. This Medicare coverage expansion will give 1.5 million more people within the U.S. access to life-saving technology.
Hopes that non-public insurance will follow
While that is an important win for the diabetes community, private medical health insurance coverage of CGMs continues to be unstable. Individuals with diabetes must often navigate an advanced web of medical health insurance obstacles and barriers to accessing these devices. Not all insurance policy cover CGMs for individuals with diabetes.
Sometimes, initiatives like this will spur change within the private sector. That future is yet to be seen, however the diabetes community is hopeful and continues to advocate. Often, private medical health insurance plans look to Medicaid and Medicare when determining their coverage policies—an expansion as significant as that is certain to make waves.
This content mentions Dexcom, an lively partner of Beyond Type 1.
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