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AMCP Market Insights Health Plan Best Practices: Implementing Continuous Glucose Monitoring Interventions to Improve Outcomes for Members with Diabetes

August 30, 2023
Coverage and Benefit Design
Webinar / Archive

CGM has advanced diabetes management, with demonstrated improvements in glycemic management, reduction of hypoglycemia-related resource utilization, and enhanced member engagement and self-management. While this technology was initially prescribed predominantly for those living with type 1 diabetes (T1D), the mounting body of evidence and expert recommendations have led to more widespread use in insulin-treated T2D, necessitating the implementation of evidence-based benefit design policies by health plans. During this working group meeting, leading payer and managed care decision makers reviewed recent findings and shared their insights on best practices for CGM coverage and reimbursement, including alignment with clinical practice guidelines, availability under the pharmacy benefit, and automated adjudication at the point of sale.

Jim Kenney, RPh, MBA (Moderator)
Founder and President
JTKenney, LLC
Sheri Dolan, BSPharm
Clinical Pharmacist, Healthcare and Family Services
Bureau of Professional and Ancillary Services
University of Illinois at Chicago
Thomas Grace, MD
Medical Director
Blanchard Valley Diabetes Center
Estay Greene, PharmD, MBA
Vice President of Pharmacy
Zing Health
Eric Long, PharmD, MBA
Disease Management Pharmacist
Beacon Health System
Scott McClelland, PharmD
Vice President, Commercial and Specialty Pharmacy Programs
Florida Blue
Josh Moore, PharmD
Director of Pharmacy
MO HealthNet Division
Missouri Department of Social Services
Diane E. Morgan, PharmD
Director, Specialty Pharmacy
Government Programs Pharmacy
Heather Mullins, PMP
Senior Clinical Program Manager
Susan Wescott, RPh, MBA
Executive Lead, Clinical Services, Alluma, LLC
Senior Director of Pharmacy, Managed Care, Mayo Clinic