CGMs and Medicare

It's time to cover this LIFE-Saving technology

Continuous glucose monitoring is an important part of my diabetes management. I don’t like that people covered by Medicare are being denied coverage for this useful tool.

Infographic about CGMs and Medicare

At first blush, it may seem expensive for Medicare to cover CGM’s for their members.

But if CGMs reduce hospitalizations from lows it may actually save money.

How do we change this? DPAC!

Thankfully, we have friends who are passionate about making advocacy simple. Christel & Bennet have worked very hard to build the Diabetes Patient Advocacy Coalition, and through DPAC it is dead simple to send a quick message asking your representatives to support this. You don’t even need to know who they are (DPAC does it for you). 

DPAC’s tools are even smart enough to know whether your representatives have already signed on, and if so, you’ll be sending a thank you letter – automatically.

And yes, you can help if you don’t have diabetes. If someone you care about lives with diabetes, let your representatives know that you want their support on this. We need your help too!

Through DPAC’s easy tools, you can help fill the syringe…

October Syringe

And help color the map…

support map

Please click through to DPAC’s “Send a Message” page. It’s fast, it’s easy, and it makes a difference.

Graphics provided by HCM Strategists. Full-size copies: Medicare-CGM Infographic, House-CGM, Support Map

 

 

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4 thoughts on “CGMs and Medicare

  1. This is a huge issue in my home country, Sweden. I sent a letter a while ago to people responsible for this but got no answer. The issue is to make the politicians think in the long term. They need to understand that the investment we do today will pay off tomorrow. Today I can only get a CGM if my diabetes is very unstable or if I am a kid. Otherwise, I have to pay $80 per sensor (Medtronic).

    /Robin

  2. Thanks, Scott! This page is very nicely designed and presented. Here is my story:

    I have an MVP health insurance plan. It is affiliated with Medicare, so MVP must follow Medicare rules. Dexcom tried to get their CGM approved for me. It was denied. My endo then presented a letter of medical necessity to MVP, mentioning my hypo unawareness. I was turned down again. Here is the explanation from MVP for the denial:

    “Per the MVP Policy Continuous Glucose Monitoring long-term continuous glucose monitoring systems beyond 72 hours (A9276, A9277, A2978) are not covered for Medicare products. Therefore the request is denied.”

    The denial is not very well worded. I think they are objecting to a device that is used in the skin for more than 3 days. An infusion set for a pump is usually recommended for 2 days, but many of us use them for 3 days. So MVP/Medicare approves pumps and infusion sets. A CGM sensor is recommended for 7 days, and many of us use them for 14 days, or longer. That is much longer than the 3 days approved, so MVP/Medicare denies coverage of a CGM.

    I wonder why having a sensor in my skin for more than 3 days is considered inappropriate by Medicare. Does anyone know?