In The News
CGM use was associated with -0.62% A1c reduction at 3 months in people with diabetes on basal only or non-insulin therapies in the primary care setting. CGM use significantly improved glycemic control in T2D patients irrespective of treatment regimen (non-insulin or basal insulin). This study was conducted in collaboration with the American Medical Group Association (AMGA).
Learn MoreAn expert panel of 4 payer and 6 provider stakeholders was convened to discuss opportunities for CGM-based care management in risk-sharing agreements between payers and providers. The panelists were surveyed before 2 virtual roundtable meetings, during which pertinent clinical and trend data were shared.
All payer participants cited using interdisciplinary care management for type 2 diabetes (T2D) and 50% used a digital health platform, but only 25% featured an integrated CGM component. All payer participants responded that “fingerstick” glucose management was either inadequate or questionable for use in current care management programs for T2D. Conversely, 100% also responded that CGM would improve their care delivery solutions. These findings were published as an abstract in the Journal of Managed Care and Specialty Pharmacy and presented in a poster at the 2025 Academy of Managed Care Pharmacy Annual Meeting, including parameters for optimizing risk-sharing agreements incorporating CGM. Specifically, the expert panelists outlined 3 key elements of risk-sharing agreements: agreement design, realistic outcomes measures, and strategies to facilitate payer and provider participation. The recommendations provided by the panel may be valuable for managed care and payer decision makers in shaping risk-sharing agreements to advance the utilization of CGM and improve member outcomes in the management of T2D.
Albright J, McCormick D, Pourarsalan H, Pangrace M. Payer-Provider Risk-Sharing Agreements to Advance Continuous Glucose Monitoring–Based Care in Type 2 Diabetes. Presented at the AMCP Annual Meeting; Houston, TX: April 2, 2025. [Poster E6.]
Learn MoreThe Ohio Diabetes Quality Improvement Project (QIP), focused on multisector collaborative approaches, reduced the percentage of patients with A1c >9% from 25% to 20% over two years. In response to barriers voiced by providers and patients, Medicaid payers added coverage for diabetes self-management education and removed prior authorization requirements for continuous glucose monitoring (CGM) within select populations. These efforts enhanced equity to Medicaid enrollees by making it easier to obtain and afford diabetes management supplies and resources.
Learn MoreThe recently issued 2025 ADA Standards of Care offered new guidance supporting CGM use in broader patient populations, the application of CGM metrics in achieving glycemic goals, and the integration of CGM with other diabetes technologies at diagnosis. Specifically, the 2025 Standards of Care recommend considering the use of CGM in adults with T2D NIT to achieve and maintain individualized glycemic goals. Reasserting the clinical value of CGM in type 1 diabetes in pregnancy, the ADA added that CGM may also be beneficial for gestational diabetes and T2D in pregnancy in the 2025 update. ADA also expanded their recommendation for CGM use in individuals with diabetes on any insulin therapy to include youths as well as adults. While previous versions of the Standards of Care stated that CGM metrics should not be used as a substitute for BGM, the 2025 update notes that CGM metrics can be used in conjunction with blood glucose monitoring to achieve glycemic goals. Highlighting the importance of early intervention, the ADA also recommends initiation of CGM, continuous subcutaneous insulin infusion, and automated insulin delivery at diagnosis, depending on a person’s or caregiver’s needs and preferences. These updates are relevant to managed care and payer decision makers in the development of clinically appropriate coverage policies that enhance access to CGM in broader patient populations.
American Diabetes Association Professional Practice Committee. Summary of Revisions: Standards of Care in Diabetes-2025. Diabetes Care. 2025;48(1 Suppl 1):S6-S13.
Learn MoreA retrospective observational study using Aetna administrative claims data showed that CGM use was associated with clinically meaningful improvements in A1c and reduced health care resource utilization. The study, published in the Journal of Managed Care and Specialty Pharmacy, looked at a cohort of fully insured commercial and Medicare Advantage beneficiaries with diabetes and coverage for medical and pharmacy benefits. Data from 7,336 patients (74% T2D, mean age 57 years, 42% Medicare-insured, 54% male, 56% White) showed a significant improvement in A1c after CGM initiation (-0.7%, P<0.0001), including a -0.9% change in the T2D not on insulin group (n = 264). For the overall cohort, the number of patients with diabetes-related hospitalizations and emergency department visits decreased significantly by 67% and 40%, respectively (P<0.0001 for both). This real-world analysis suggests a potential for population-level clinical and economic benefits with CGM in a managed care setting, particularly among patients not using insulin.
Learn MoreClinical practice guidelines endorse the use of CGM, and CMS recently expanded coverage for this technological intervention. However, disparities due to racial/ethnic bias, insurance coverage, and healthcare literacy present barriers to equitable diabetes care and access to CGM. Data show that members of minority populations, those with lower socioeconomic status and those without private insurance are disproportionately affected by diabetes and have lower rates of CGM use. This article, published in Managed Healthcare Executive, notes that payers should place greater emphasis on expanding patient education programs. In addition, further action must be taken to inform patients and to increase adoption and dissemination of new diabetes care technology. In addition to enhancing provider knowledge of CGM and its role in optimal patient care, managed care and payer professionals are tasked with ensuring that unnecessary barriers do not exist in current coverage policies.
In an accompanying video series, Estay Greene, PharmD, MBA, provides insights on ways to improve the care of patients with diabetes from the payer persepective, with a focus on data supporting the use of CGM. Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES, FADCES, FCCP, and David Hines also share their perspectives on social determinants of health in diabetes management and overcoming disparities in care with appropriate use of CGM.
Learn MoreThis Payer IMPACT Brief summarizes the key points of a Satellite Symposium held at the Academy of Managed Care Pharmacy 2024 Annual Meeting.
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Intended Audience: This activity is designed to meet the education needs of managed are pharmacy directors, registered nurses, clinical pharmacists, quality directors and medical directors.
Credit Available: Up to 1.0 credit hour available for nurses (ANCC), pharmacists (ACPE), and physicians (AMA PRA Category 1 Credit™)
Expiration Date: December 31, 2025
Educational Objectives
After completing this activity, the participant should be better able to:
- Describe recent updates to HEDIS measures in diabetes care, including opportunities associated with glucose management indicator (GMI) and an increased focus on equity
- Describe the synergistic impact of CGM and GLP-1 agonists
- Outline health plan best practices and strategies for streamlined coverage, access, and value of CGM
Expert Faculty
Clinical Pharmacist, Medicare Stars & Clinical Quality
Optum Rx
Jointly provided by Impact Education, LLC, and Medical Education Resources.
This continuing education activity is supported by an independent educational grant from Dexcom, Inc. Medical Affairs.
A poster presented at the Academy of Managed Care Pharmacy’s (AMCP) annual meeting in New Orleans, LA, shared data from a health initiative by Metro Nashville Public Schools. The employer provided CGM devices as a pharmacy benefit without prior authorization. This policy change led to a two-fold increase in CGM utilization among employees aged 18 to 64 years with T1D and T2D regardless of treatment regimen. The retrospective analysis, covering 184 participants, showed significant improvements in glycemic control associated with CGM use. Specifically, average A1c decreased from 8.7% to 7.9% and from 7.6% to 6.8% among those with T2D treated with insulin and not-treated with insulin, respectively. Additionally, CGM use resulted in a significant improvement in the proportion of individuals meeting the HEDIS and ADA HbA1c targets of <8.0% and <7.0%, respectively. These results underscore the potential benefits of CGM for improving diabetes management through streamlined health care payer and purchaser coverage.
Learn MoreThe poster outlines best practices for health plan coverage and access to Continuous Glucose Monitoring (CGM) for diabetes management, emphasizing the technology’s transformative impact on care. It recommends aligning coverage criteria with current medical evidence, enhancing utilization oversight, and improving access for underserved populations. Strategies include offering CGM under pharmacy benefits, educating healthcare providers and patients, and developing support systems for at-risk groups. The best practices, derived from expert interviews, a national survey, and a workshop, aim to assist health plan decision makers in optimizing diabetes outcomes and managing healthcare costs efficiently.
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