ManagedCareCGM

Continuous Glucose Monitoring

Education for Managed Care, Pharmacy, and Payer Professionals

CME/CNE/CPE Case Study:

Best Practices in CGM Benefit Design: Payer Experience Moving CGM Coverage from the Medical to the Pharmacy Benefit

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Leveraging Diabetes Health Technology in Managed Care and Coverage Considerations for Real-Time Continuous Glucose Monitoring

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New CME/CNE/CPE Activity:

Continuous Glucose Monitoring and the Opportunities for Optimal Diabetes Care and Cost Management

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Latest Expert Interview

CGM Quick Facts


  • There are more than 30 million Americans with diabetes at an estimated cost of >$327 billion per year
  • The cost to treat the complications of diabetes alone total $44.1 billion per year
  • Patients with type 1 diabetes (T1D) report an average of up to 3 episodes of severe hypoglycemia per year (episodes requiring the assistance of another person).
  • Studies using continuous glucose monitoring (CGM) show much more frequent episodes of clinically important hypoglycemia (<54 mg/dL), ranging from every 2-4 days to every 6 days.
  • Based on previous cost estimates for hypoglycemia, nearly 100,000 ED visits and 30,000 hospitalizations annually, more than $600 million was spent on drug-related hypoglycemia during a 5-year period (2007-2011).
  • CGM represents a new paradigm of care in diabetes, allowing for more precise and accurate management, with demonstrated reductions in A1C and time spent in hypoglycemia
  • CGM is recommended by the American Diabetes Association (ADA) and other endocrinology-related professional societies in appropriate clinical scenarios for both type 1 and type 2 diabetes but is vastly underutilized

CGM Quick Facts References:

2018 Drug Trend Report. Express Scripts website: https://www.express-scripts.com/corporate/drug-trend-report.

Standards of medical care in diabetes—2013. Diabetes Care. 2013;36 Suppl 1:S11-66.

Pedersen-Bjergaard U, Thorsteinsson B. Reporting Severe Hypoglycemia in Type 1 Diabetes: Facts and Pitfalls. Curr Diab Rep. 2017; 17:131.

Geller KI,  Shehab N, Lovegrove MC, Kegler SR, Weidenbach KN, Ryan GJ, & Budnitz DS. (2014). National estimates of insulin-related hypoglycemia and errors leading to emergency department visits and hospitalizations. JAMA Intern Med, 174(5):678-686.

Riddlesworth T, Price D, Cohen N, Beck RW. Hypoglycemic Event Frequency and the Effect of Continuous Glucose Monitoring in Adults with Type 1 Diabetes Using Multiple Daily Insulin Injections. Diabetes Ther. 2017; 8:947.

ADA Standards of Medical Care in Diabetes- 2019.

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Questionnaire


Q1: What best describes your primary role?

Q2: Approximately how many patients with diabetes are being managed in your organization or practice setting?

Q3: How familiar are you with the benefits of real-time continuous glucose monitoring (rtCGM) in the management of patients with diabetes?

Not Familiar Very Familiar

Q4: In your organization, how is rtCGM covered?

Q5: Which of the below topics do you most need further information on?

Advisory Board

Joseph Albright, PharmD

Manager, Clinical Pharmacy Services
BlueCross BlueShield North Carolina

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

Jeffrey D. Dunn, PharmD, MBA

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

Vanita Pindolia, PharmD, BCPS, MBA

Vice President, Ambulatory Clinical Pharmacy Programs_PCM
Henry Ford Health System/Health Alliance Plan of Michigan