Skip to Main Content

Author: Tom Sager

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
UnitedHealthcare
Heather Mullins, PMP
Senior Clinical Program Manager
UnitedHealthcare
Susan Wescott, RPh, MBA
Executive Lead, Clinical Services, Alluma, LLC
Senior Director of Pharmacy, Managed Care, Mayo Clinic

Share:
August 3, 2023
Clinical Outcomes
Article / Publication

This article reports key findings from recent randomized, observational, and retrospective studies investigating use of CGM in type 2 diabetes (T2D) individuals treated with basal insulin only and/or noninsulin therapies. Data from 29 studies were reviewed and analyzed. Both randomized and prospective/retrospective studies have demonstrated significant glycemic improvement, reductions in diabetes-related events and hospitalization rates, and cost benefits of persistent CGM use by individuals with T2D who are treated with basal insulin only, basal plus noninsulin medications, and noninsulin medications without insulin. In 23 (79%) of the 29 studies reviewed, investigators reported associations between CGM and improvements in HbA1c and/or key CGM metrics. These findings, alone, provide strong evidence that supports providing access to this technology to those with T2D who are less intensively treated. The narrative presents an evidence-based rationale for expanded access to CGM within the T2D basal insulin only and/or noninsulin treated population. Recent clinical guidelines from the American Diabetes Association and American Association of Clinical Endocrinology now endorse CGM use in individuals treated with nonintensive insulin regimens. Access in the basal insulin only population has expanded since the start of this project. CGM should be made readily available to all individuals with diabetes who are able to use this technology safely and effectively.

Learn More
Share:
March 17, 2023
Economic Outcomes
CGM Best Practices / Interview

Expert: Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES, FADCES, FCCP, Endocrine Clinical Pharmacy Specialist, Co-Director, Endocrine Disorders in Pregnancy, Cleveland Clinic Endocrinology & Metabolism Institute

Summary: Opportunities to improve care quality and reduce costly resource utilization in diverse patient populations with evidence-based utilization of CGM

Share:
March 2, 2023
Population Health
CE Activities

Intended Audience: This activity is designed to meet the educational needs of medical directors, registered nurses, pharmacy directors, clinical pharmacists, specialty pharmacists, quality directors, as well as network physicians affiliated with various MCOs, health systems, and other payer organizations.

Credit Available: Up to 0.5 credit hour available for nurses (ANCC), pharmacists (ACPE), and physicians (AMA PRA Category 1 Credit™)

Expiration Date:  August 31, 2024

Click here to begin!

Educational Objectives
After completing this activity, the participant should be better able to:

  • Describe the clinical outcomes of real-time continuous glucose monitoring initiation in insulin-treated patients with diabetes
  • Access health plan opportunities to improve diabetes outcomes for patients with diabetes based on current treatment guidelines and quality measures
  • Identify how multi-disciplinary care teams can support quality improvement interventions for patients with diabetes

Expert Faculty

Richard Dlott, MD

Managing Director

FourthFlight

Jeffrey Dunn, PharmD, MBA

Chief Clinical Officer

Cooperative Benefits Group

Jointly provided by Impact Education, LLC, and Medical Education Resources.
This continuing education activity is supported by an independent educational grant from Dexcom, Inc.

Share:
December 22, 2020
Population Health
CGM Best Practices / Interview

Expert: (Formerly) Vice President Clinical Strategy and Programs and Industry Relations, MagellanRx Management (Currently Chief Clinical Officer, Cooperative Benefits Group)

Summary: In this video interview Dr. Dunn discusses best practices and considerations for payers when they consider moving CGM coverage to the pharmacy benefit, application of utilization management, and more.

Share:
December 21, 2019
CGM Technology and Digital Health
CGM Best Practices / Interview

Expert: Thomas Danne, MD, Professor of Pediatrics at Children’s Hospital Auf der Bult

Summary: In this 3-part video interview Professor Danne discussion the opportunities and challenges presented by glycemic control, time in range and reduction in diabetes-related complications, virtual care and the future of CGM.

Share:
  • 1-0 of 0 results