ManagedCareCGM

This site is intended for managed care professionals in the U.S.

This site is intended for managed care professionals in the U.S.

Professionals in Canada should visit CanadaCGM.com

Continuous Glucose Monitoring

Education for Managed Care, Pharmacy, and Payer Professionals

 

Featured Article

Continuous Glucose Monitoring: An Opportunity for Population-Based Diabetes Management

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Addressing Social Determinants of Health (SDOH) and Racial/Ethnic Disparities in Diabetes with Real-Time CGM

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Payer Perspectives on the Value of Real-Time Continuous Glucose Monitoring

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CMS expands Medicare coverage for CGM, eliminating requirement of 4 fingersticks per day prior to accessing CGM

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Lower A1c and Reduce Hospital/ED Use in Members with Insulin-Treated Type 2 Diabetes via Real-Time Continuous Glucose Monitoring

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Spotlight on Quality:

Quality Talks 2022: Diana Isaacs, PharmD, and the Transformation of Diabetes through Time in Range

Recent News:

On October 6, CMS’ DME claims processing contractors released a Proposal to modify Medicare’s CGM coverage policy.
  • CGM coverage is proposed for individuals with diabetes taking as little as one administration of insulin per day (basal only). This differs from the current policy that requires Medicare beneficiaries to use three or more administrations of insulin per day.
  • CGM coverage is proposed for people who are taking no insulin, but have a diabetes diagnosis and who have a history of problematic hypoglycemia with documentation of at least one of the following:
    • Recurrent level 2 hypoglycemic events (glucose <54mg/dL (3.0mmol/L) that persist despite multiple (2 or more) attempts to adjust medication(s) and/or modify the diabetes treatment plan; or
    • A history of one level 3 hypoglycemic event (glucose <54mg/dL (3.0mmol/L) characterized by altered mental and/or physical state requiring third-party assistance for treatment of hypoglycemia
  • The initial visit to obtain a CGM and visits required every six months thereafter to continue on CGM can be done either in-person, or via telehealth, whereas previously they could only be in-person.

Conference Update:

ADA 2022: Spotlight on Real-World Evidence Supporting the Use of Real-Time Continuous Glucose Monitoring

Click here for a summary of key posters that highlight findings on the value of rtCGM pertinent to managed care and payer decision makers.

Featured Article:

Continuous Glucose Monitoring: An Opportunity for Population-Based Diabetes Management 

Programmatic integrated approaches have been used successfully and cost-effectively to manage various chronic conditions. The incorporation of rtCGM in similar integrated approaches to diabetes management presents an opportunity to improve quality outcomes and reduce costs on a population level. This publication details the evidence to suggest it may be time to support broader adoption to incorporate the use of rtCGM.

Featured Resource:

Highlights From a CGM Expert Interview With Thomas Grace, MD

In the second installment in a new series of video resources hosted on ManagedCareCGM.com, Dr. Thomas Grace, Medical Director at the Blanchard Valley Diabetes Center in Findlay, Ohio, describes the steps taken to implement a rtCGM-centered management program and the clinical utility of rtCGM in primary care.

Click here for the full interview.

Advisory Board

Joseph Albright, PharmD

Manager, Clinical Pharmacy Services
BlueCross BlueShield North Carolina
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Jeffrey D. Dunn, PharmD, MBA

(Formerly) Vice President, Clinical Strategy and Programs and Industry Relations
MagellanRx Management
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Daniel DeSalvo, MD

Assistant Professor of Pediatrics
Director of Strategic Collaboration
Diabetes Clinic CPT Co-Director
Section of Pediatric Diabetes & Endocrinology
Baylor College of Medicine/Texas Children's Hospital
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