Author: Tom Sager
Program Description
Patients with diabetes who are hospitalized and have uncontrolled blood glucose levels are at a higher risk for morbidity, mortality, and health care costs. Pharmacists practicing within hospital and health-system settings can identify patients who might benefit from continuous glucose monitoring (CGM) devices. This program will outline responsibilities for health-system pharmacists to improve the integration of CGM into practice for appropriate patients. The panelists will discuss insurance coverage options, potential cost considerations, and the importance of follow-up communication with patients to address initial challenges. Panelists will share their collective experience and discuss opportunities for collaboration to ensure a smooth transition to CGM use after discharge.
Target audience: Health-system and community pharmacists
Type of activity: Application
This video reviews recent findings on the use of CGM. The studies highlight real world evidence supporting the broader use and
benefit of CGM at the patient and population level. Key takeaways include:
- The use of CGM has demonstrated clinical utility in non-intensively treated type two diabetes, including individuals using
non-insulin agents - CGM has shown an A1c reduction across diverse population who have historically experienced disparities in access to CGM
- CGM has demonstrated a clinical value in individuals also utilizing GLP1
- CGM is linked to reduced mortality in people with type one and type two diabetes using insulin
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 | Clinical Pharmacist, Healthcare and Family Services Bureau of Professional and Ancillary Services University of Illinois at Chicago |
 Thomas Grace, MDMedical Director Blanchard Valley Diabetes Center |  Estay Greene, PharmD, MBAVice President of Pharmacy Zing Health |
 Eric Long, PharmD, MBADisease Management Pharmacist Beacon Health System |  Scott McClelland, PharmDVice President, Commercial and Specialty Pharmacy Programs Florida Blue |
 Josh Moore, PharmDDirector of Pharmacy MO HealthNet Division Missouri Department of Social Services |  Diane E. Morgan, PharmDDirector, Specialty Pharmacy Government Programs Pharmacy UnitedHealthcare  |
 Heather Mullins, PMPSenior Clinical Program Manager UnitedHealthcare |  Susan Wescott, RPh, MBAExecutive Lead, Clinical Services, Alluma, LLC Senior Director of Pharmacy, Managed Care, Mayo Clinic |
In support of this working group, a survey of managed care professionals was conducted. Click here to download the results.
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.
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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
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™)
Expired
Click here to review- CE ExpiredEducational 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
Jointly provided by Impact Education, LLC, and Medical Education Resources.
This continuing education activity is supported by an independent educational grant from Dexcom, Inc.
Click here to download the summary from this live event or watch the webinar video archive below.
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.
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.
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