Evidence
PayerTalkCE™ Presents: Continuous Glucose Monitoring: Improving Access to CGM Under the Pharmacy Benefit
November 2, 2023Coverage and Benefit Design 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: April 30, 2025
Click here to begin!
Educational Objectives
After completing this activity, the participant should be better able to:
- Describe employer/PBM coverage criteria for CGM and the clinical evidence supporting the criteria
- Assess the challenges associated with prior authorization
- Identify opportunities for improved access and reduced administrative burden
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. Medical Affairs.
November 1, 2023Economic Outcomes Article / PublicationLearn MoreOctober 12, 2023Clinical Outcomes Population Health Article / PublicationLearn More
Learn MoreUse of Continuous Glucose Monitors Upon Hospital Discharge of People with Diabetes: Promise, Barriers, and Opportunity
October 2, 2023Population Health Article / PublicationLearn MoreSeptember 15, 2023Clinical Outcomes Video
This video resource highlights evidence—presented at the 83rd American Diabetes Association (ADA) Scientific Sessions—demonstrating the clinical, economic, and humanistic value of continuous glucose monitoring (CGM) in type 2 diabetes (T2D) for managed care and payer professionals. Abstracts presented in this video underscore the burden of hypoglycemia in T2D and the potential for CGM to improve clinical outcomes and manage disease-related costs regardless of treatment regimen or prescriber type. Key areas of focus pertinent to managed care and payer professionals include the benefits of CGM initiation on Healthcare Effectiveness Data and Information Set (HEDIS) measure performance, utilization of emergency department/hospital services, and patient adherence. This information is delivered in a multimedia infographic format, with quotes from managed care and payer key opinion leaders interspersed for maximum impact. The video concludes with a summary of best practices to facilitate streamlined coverage and access to CGM in alignment with the latest clinical evidence and expert recommendations.
Integration of Continuous Glucose Monitoring Data into an Electronic Health Record System: Single-Center Implementation
August 30, 2023CGM Technology and Digital Health Article / PublicationLearn MoreAMCP Market Insights Health Plan Best Practices: Implementing Continuous Glucose Monitoring Interventions to Improve Outcomes for Members with Diabetes
August 30, 2023Coverage 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
In support of this working group, a survey of managed care professionals was conducted. Click here to download the results.
Evidence-Based Rationale for Expanding Access to CGM in Individuals with Type 2 Diabetes Treated with Nonintensive Therapies
August 3, 2023Clinical 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 MoreAugust 1, 2023Featured News & Info Guidelines / Policy
Learn MoreJuly 14, 2023Population Health Infographic
This infographic highlights the value of CGM for positively impacting diabetes care quality, with special consideration given to underserved demographics of patients based on race/ethnicity and age. The piece links to the 2023 AMCP symposium moderated by Dr. Gary Puckrein, President and Chief Executive Officer of the National Minority Quality Forum, where diabetes care disparities and quality were also brought into focus. Also linked is an expert interview with Diana Isaacs, PharmD, with insights on disparities in diabetes care and quality considerations. Guidance is offered on improving CGM access as a means for meeting recent HEDIS quality measures tied to reducing emergency department and hospital use. Using findings from Blue Cross Blue Shield North Carolina as a case study, the infographic serves as a call-to-action for payers to remove manual prior authorizations for CGM under the pharmacy benefit.
Sign Up To Stay Current On The Latest Coverage
Updates, Recent News, And Resources
PayerTalkCE™ Presents: Continuous Glucose Monitoring: Improving Access to CGM Under the Pharmacy Benefit
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: April 30, 2025
Click here to begin!Educational Objectives
After completing this activity, the participant should be better able to:
- Describe employer/PBM coverage criteria for CGM and the clinical evidence supporting the criteria
- Assess the challenges associated with prior authorization
- Identify opportunities for improved access and reduced administrative burden
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. Medical Affairs.
November 1, 2023Economic Outcomes Article / PublicationLearn MoreOctober 12, 2023Clinical Outcomes Population Health Article / PublicationLearn More
Learn MoreUse of Continuous Glucose Monitors Upon Hospital Discharge of People with Diabetes: Promise, Barriers, and Opportunity
October 2, 2023Population Health Article / PublicationLearn MoreSeptember 15, 2023Clinical Outcomes Video
This video resource highlights evidence—presented at the 83rd American Diabetes Association (ADA) Scientific Sessions—demonstrating the clinical, economic, and humanistic value of continuous glucose monitoring (CGM) in type 2 diabetes (T2D) for managed care and payer professionals. Abstracts presented in this video underscore the burden of hypoglycemia in T2D and the potential for CGM to improve clinical outcomes and manage disease-related costs regardless of treatment regimen or prescriber type. Key areas of focus pertinent to managed care and payer professionals include the benefits of CGM initiation on Healthcare Effectiveness Data and Information Set (HEDIS) measure performance, utilization of emergency department/hospital services, and patient adherence. This information is delivered in a multimedia infographic format, with quotes from managed care and payer key opinion leaders interspersed for maximum impact. The video concludes with a summary of best practices to facilitate streamlined coverage and access to CGM in alignment with the latest clinical evidence and expert recommendations.
Integration of Continuous Glucose Monitoring Data into an Electronic Health Record System: Single-Center Implementation
August 30, 2023CGM Technology and Digital Health Article / PublicationLearn MoreAMCP Market Insights Health Plan Best Practices: Implementing Continuous Glucose Monitoring Interventions to Improve Outcomes for Members with Diabetes
August 30, 2023Coverage 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
In support of this working group, a survey of managed care professionals was conducted. Click here to download the results.
Evidence-Based Rationale for Expanding Access to CGM in Individuals with Type 2 Diabetes Treated with Nonintensive Therapies
August 3, 2023Clinical 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 MoreAugust 1, 2023Featured News & Info Guidelines / Policy
Learn MoreJuly 14, 2023Population Health Infographic
This infographic highlights the value of CGM for positively impacting diabetes care quality, with special consideration given to underserved demographics of patients based on race/ethnicity and age. The piece links to the 2023 AMCP symposium moderated by Dr. Gary Puckrein, President and Chief Executive Officer of the National Minority Quality Forum, where diabetes care disparities and quality were also brought into focus. Also linked is an expert interview with Diana Isaacs, PharmD, with insights on disparities in diabetes care and quality considerations. Guidance is offered on improving CGM access as a means for meeting recent HEDIS quality measures tied to reducing emergency department and hospital use. Using findings from Blue Cross Blue Shield North Carolina as a case study, the infographic serves as a call-to-action for payers to remove manual prior authorizations for CGM under the pharmacy benefit.
Sign Up To Stay Current On The Latest Coverage
Updates, Recent News, And Resources
October 12, 2023Clinical Outcomes Population Health Article / PublicationLearn More
Learn MoreUse of Continuous Glucose Monitors Upon Hospital Discharge of People with Diabetes: Promise, Barriers, and Opportunity
October 2, 2023Population Health Article / PublicationLearn MoreSeptember 15, 2023Clinical Outcomes Video
This video resource highlights evidence—presented at the 83rd American Diabetes Association (ADA) Scientific Sessions—demonstrating the clinical, economic, and humanistic value of continuous glucose monitoring (CGM) in type 2 diabetes (T2D) for managed care and payer professionals. Abstracts presented in this video underscore the burden of hypoglycemia in T2D and the potential for CGM to improve clinical outcomes and manage disease-related costs regardless of treatment regimen or prescriber type. Key areas of focus pertinent to managed care and payer professionals include the benefits of CGM initiation on Healthcare Effectiveness Data and Information Set (HEDIS) measure performance, utilization of emergency department/hospital services, and patient adherence. This information is delivered in a multimedia infographic format, with quotes from managed care and payer key opinion leaders interspersed for maximum impact. The video concludes with a summary of best practices to facilitate streamlined coverage and access to CGM in alignment with the latest clinical evidence and expert recommendations.
Integration of Continuous Glucose Monitoring Data into an Electronic Health Record System: Single-Center Implementation
August 30, 2023CGM Technology and Digital Health Article / PublicationLearn MoreAMCP Market Insights Health Plan Best Practices: Implementing Continuous Glucose Monitoring Interventions to Improve Outcomes for Members with Diabetes
August 30, 2023Coverage 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
In support of this working group, a survey of managed care professionals was conducted. Click here to download the results.
Evidence-Based Rationale for Expanding Access to CGM in Individuals with Type 2 Diabetes Treated with Nonintensive Therapies
August 3, 2023Clinical 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 MoreAugust 1, 2023Featured News & Info Guidelines / Policy
Learn MoreJuly 14, 2023Population Health Infographic
This infographic highlights the value of CGM for positively impacting diabetes care quality, with special consideration given to underserved demographics of patients based on race/ethnicity and age. The piece links to the 2023 AMCP symposium moderated by Dr. Gary Puckrein, President and Chief Executive Officer of the National Minority Quality Forum, where diabetes care disparities and quality were also brought into focus. Also linked is an expert interview with Diana Isaacs, PharmD, with insights on disparities in diabetes care and quality considerations. Guidance is offered on improving CGM access as a means for meeting recent HEDIS quality measures tied to reducing emergency department and hospital use. Using findings from Blue Cross Blue Shield North Carolina as a case study, the infographic serves as a call-to-action for payers to remove manual prior authorizations for CGM under the pharmacy benefit.
Sign Up To Stay Current On The Latest Coverage
Updates, Recent News, And Resources
Use of Continuous Glucose Monitors Upon Hospital Discharge of People with Diabetes: Promise, Barriers, and Opportunity
October 2, 2023Population Health Article / PublicationLearn MoreSeptember 15, 2023Clinical Outcomes Video
This video resource highlights evidence—presented at the 83rd American Diabetes Association (ADA) Scientific Sessions—demonstrating the clinical, economic, and humanistic value of continuous glucose monitoring (CGM) in type 2 diabetes (T2D) for managed care and payer professionals. Abstracts presented in this video underscore the burden of hypoglycemia in T2D and the potential for CGM to improve clinical outcomes and manage disease-related costs regardless of treatment regimen or prescriber type. Key areas of focus pertinent to managed care and payer professionals include the benefits of CGM initiation on Healthcare Effectiveness Data and Information Set (HEDIS) measure performance, utilization of emergency department/hospital services, and patient adherence. This information is delivered in a multimedia infographic format, with quotes from managed care and payer key opinion leaders interspersed for maximum impact. The video concludes with a summary of best practices to facilitate streamlined coverage and access to CGM in alignment with the latest clinical evidence and expert recommendations.
Integration of Continuous Glucose Monitoring Data into an Electronic Health Record System: Single-Center Implementation
August 30, 2023CGM Technology and Digital Health Article / PublicationLearn MoreAMCP Market Insights Health Plan Best Practices: Implementing Continuous Glucose Monitoring Interventions to Improve Outcomes for Members with Diabetes
August 30, 2023Coverage 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
In support of this working group, a survey of managed care professionals was conducted. Click here to download the results.
Evidence-Based Rationale for Expanding Access to CGM in Individuals with Type 2 Diabetes Treated with Nonintensive Therapies
August 3, 2023Clinical 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 MoreAugust 1, 2023Featured News & Info Guidelines / Policy
Learn MoreJuly 14, 2023Population Health Infographic
This infographic highlights the value of CGM for positively impacting diabetes care quality, with special consideration given to underserved demographics of patients based on race/ethnicity and age. The piece links to the 2023 AMCP symposium moderated by Dr. Gary Puckrein, President and Chief Executive Officer of the National Minority Quality Forum, where diabetes care disparities and quality were also brought into focus. Also linked is an expert interview with Diana Isaacs, PharmD, with insights on disparities in diabetes care and quality considerations. Guidance is offered on improving CGM access as a means for meeting recent HEDIS quality measures tied to reducing emergency department and hospital use. Using findings from Blue Cross Blue Shield North Carolina as a case study, the infographic serves as a call-to-action for payers to remove manual prior authorizations for CGM under the pharmacy benefit.
Sign Up To Stay Current On The Latest Coverage
Updates, Recent News, And Resources
Use of Continuous Glucose Monitors Upon Hospital Discharge of People with Diabetes: Promise, Barriers, and Opportunity
September 15, 2023Clinical Outcomes Video
This video resource highlights evidence—presented at the 83rd American Diabetes Association (ADA) Scientific Sessions—demonstrating the clinical, economic, and humanistic value of continuous glucose monitoring (CGM) in type 2 diabetes (T2D) for managed care and payer professionals. Abstracts presented in this video underscore the burden of hypoglycemia in T2D and the potential for CGM to improve clinical outcomes and manage disease-related costs regardless of treatment regimen or prescriber type. Key areas of focus pertinent to managed care and payer professionals include the benefits of CGM initiation on Healthcare Effectiveness Data and Information Set (HEDIS) measure performance, utilization of emergency department/hospital services, and patient adherence. This information is delivered in a multimedia infographic format, with quotes from managed care and payer key opinion leaders interspersed for maximum impact. The video concludes with a summary of best practices to facilitate streamlined coverage and access to CGM in alignment with the latest clinical evidence and expert recommendations.
Integration of Continuous Glucose Monitoring Data into an Electronic Health Record System: Single-Center Implementation
August 30, 2023CGM Technology and Digital Health Article / PublicationLearn MoreAMCP Market Insights Health Plan Best Practices: Implementing Continuous Glucose Monitoring Interventions to Improve Outcomes for Members with Diabetes
August 30, 2023Coverage 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
In support of this working group, a survey of managed care professionals was conducted. Click here to download the results.
Evidence-Based Rationale for Expanding Access to CGM in Individuals with Type 2 Diabetes Treated with Nonintensive Therapies
August 3, 2023Clinical 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 MoreAugust 1, 2023Featured News & Info Guidelines / Policy
Learn MoreJuly 14, 2023Population Health Infographic
This infographic highlights the value of CGM for positively impacting diabetes care quality, with special consideration given to underserved demographics of patients based on race/ethnicity and age. The piece links to the 2023 AMCP symposium moderated by Dr. Gary Puckrein, President and Chief Executive Officer of the National Minority Quality Forum, where diabetes care disparities and quality were also brought into focus. Also linked is an expert interview with Diana Isaacs, PharmD, with insights on disparities in diabetes care and quality considerations. Guidance is offered on improving CGM access as a means for meeting recent HEDIS quality measures tied to reducing emergency department and hospital use. Using findings from Blue Cross Blue Shield North Carolina as a case study, the infographic serves as a call-to-action for payers to remove manual prior authorizations for CGM under the pharmacy benefit.
Sign Up To Stay Current On The Latest Coverage
Updates, Recent News, And Resources
This video resource highlights evidence—presented at the 83rd American Diabetes Association (ADA) Scientific Sessions—demonstrating the clinical, economic, and humanistic value of continuous glucose monitoring (CGM) in type 2 diabetes (T2D) for managed care and payer professionals. Abstracts presented in this video underscore the burden of hypoglycemia in T2D and the potential for CGM to improve clinical outcomes and manage disease-related costs regardless of treatment regimen or prescriber type. Key areas of focus pertinent to managed care and payer professionals include the benefits of CGM initiation on Healthcare Effectiveness Data and Information Set (HEDIS) measure performance, utilization of emergency department/hospital services, and patient adherence. This information is delivered in a multimedia infographic format, with quotes from managed care and payer key opinion leaders interspersed for maximum impact. The video concludes with a summary of best practices to facilitate streamlined coverage and access to CGM in alignment with the latest clinical evidence and expert recommendations.
Integration of Continuous Glucose Monitoring Data into an Electronic Health Record System: Single-Center Implementation
August 30, 2023CGM Technology and Digital Health Article / PublicationLearn MoreAMCP Market Insights Health Plan Best Practices: Implementing Continuous Glucose Monitoring Interventions to Improve Outcomes for Members with Diabetes
August 30, 2023Coverage 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
In support of this working group, a survey of managed care professionals was conducted. Click here to download the results.
Evidence-Based Rationale for Expanding Access to CGM in Individuals with Type 2 Diabetes Treated with Nonintensive Therapies
August 3, 2023Clinical 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 MoreAugust 1, 2023Featured News & Info Guidelines / Policy
Learn MoreJuly 14, 2023Population Health Infographic
This infographic highlights the value of CGM for positively impacting diabetes care quality, with special consideration given to underserved demographics of patients based on race/ethnicity and age. The piece links to the 2023 AMCP symposium moderated by Dr. Gary Puckrein, President and Chief Executive Officer of the National Minority Quality Forum, where diabetes care disparities and quality were also brought into focus. Also linked is an expert interview with Diana Isaacs, PharmD, with insights on disparities in diabetes care and quality considerations. Guidance is offered on improving CGM access as a means for meeting recent HEDIS quality measures tied to reducing emergency department and hospital use. Using findings from Blue Cross Blue Shield North Carolina as a case study, the infographic serves as a call-to-action for payers to remove manual prior authorizations for CGM under the pharmacy benefit.
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Integration of Continuous Glucose Monitoring Data into an Electronic Health Record System: Single-Center Implementation
AMCP Market Insights Health Plan Best Practices: Implementing Continuous Glucose Monitoring Interventions to Improve Outcomes for Members with Diabetes
August 30, 2023Coverage 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
In support of this working group, a survey of managed care professionals was conducted. Click here to download the results.
Evidence-Based Rationale for Expanding Access to CGM in Individuals with Type 2 Diabetes Treated with Nonintensive Therapies
August 3, 2023Clinical 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 MoreAugust 1, 2023Featured News & Info Guidelines / Policy
Learn MoreJuly 14, 2023Population Health Infographic
This infographic highlights the value of CGM for positively impacting diabetes care quality, with special consideration given to underserved demographics of patients based on race/ethnicity and age. The piece links to the 2023 AMCP symposium moderated by Dr. Gary Puckrein, President and Chief Executive Officer of the National Minority Quality Forum, where diabetes care disparities and quality were also brought into focus. Also linked is an expert interview with Diana Isaacs, PharmD, with insights on disparities in diabetes care and quality considerations. Guidance is offered on improving CGM access as a means for meeting recent HEDIS quality measures tied to reducing emergency department and hospital use. Using findings from Blue Cross Blue Shield North Carolina as a case study, the infographic serves as a call-to-action for payers to remove manual prior authorizations for CGM under the pharmacy benefit.
Sign Up To Stay Current On The Latest Coverage
Updates, Recent News, And Resources
AMCP Market Insights Health Plan Best Practices: Implementing Continuous Glucose Monitoring Interventions to Improve Outcomes for Members with Diabetes
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.
Evidence-Based Rationale for Expanding Access to CGM in Individuals with Type 2 Diabetes Treated with Nonintensive Therapies
August 3, 2023Clinical 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 MoreAugust 1, 2023Featured News & Info Guidelines / Policy
Learn MoreJuly 14, 2023Population Health Infographic
This infographic highlights the value of CGM for positively impacting diabetes care quality, with special consideration given to underserved demographics of patients based on race/ethnicity and age. The piece links to the 2023 AMCP symposium moderated by Dr. Gary Puckrein, President and Chief Executive Officer of the National Minority Quality Forum, where diabetes care disparities and quality were also brought into focus. Also linked is an expert interview with Diana Isaacs, PharmD, with insights on disparities in diabetes care and quality considerations. Guidance is offered on improving CGM access as a means for meeting recent HEDIS quality measures tied to reducing emergency department and hospital use. Using findings from Blue Cross Blue Shield North Carolina as a case study, the infographic serves as a call-to-action for payers to remove manual prior authorizations for CGM under the pharmacy benefit.
Sign Up To Stay Current On The Latest Coverage
Updates, Recent News, And Resources
Evidence-Based Rationale for Expanding Access to CGM in Individuals with Type 2 Diabetes Treated with Nonintensive Therapies
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 MoreAugust 1, 2023Featured News & Info Guidelines / Policy
Learn MoreJuly 14, 2023Population Health Infographic
This infographic highlights the value of CGM for positively impacting diabetes care quality, with special consideration given to underserved demographics of patients based on race/ethnicity and age. The piece links to the 2023 AMCP symposium moderated by Dr. Gary Puckrein, President and Chief Executive Officer of the National Minority Quality Forum, where diabetes care disparities and quality were also brought into focus. Also linked is an expert interview with Diana Isaacs, PharmD, with insights on disparities in diabetes care and quality considerations. Guidance is offered on improving CGM access as a means for meeting recent HEDIS quality measures tied to reducing emergency department and hospital use. Using findings from Blue Cross Blue Shield North Carolina as a case study, the infographic serves as a call-to-action for payers to remove manual prior authorizations for CGM under the pharmacy benefit.
Sign Up To Stay Current On The Latest Coverage
Updates, Recent News, And Resources
July 14, 2023Population Health Infographic
This infographic highlights the value of CGM for positively impacting diabetes care quality, with special consideration given to underserved demographics of patients based on race/ethnicity and age. The piece links to the 2023 AMCP symposium moderated by Dr. Gary Puckrein, President and Chief Executive Officer of the National Minority Quality Forum, where diabetes care disparities and quality were also brought into focus. Also linked is an expert interview with Diana Isaacs, PharmD, with insights on disparities in diabetes care and quality considerations. Guidance is offered on improving CGM access as a means for meeting recent HEDIS quality measures tied to reducing emergency department and hospital use. Using findings from Blue Cross Blue Shield North Carolina as a case study, the infographic serves as a call-to-action for payers to remove manual prior authorizations for CGM under the pharmacy benefit.
This infographic highlights the value of CGM for positively impacting diabetes care quality, with special consideration given to underserved demographics of patients based on race/ethnicity and age. The piece links to the 2023 AMCP symposium moderated by Dr. Gary Puckrein, President and Chief Executive Officer of the National Minority Quality Forum, where diabetes care disparities and quality were also brought into focus. Also linked is an expert interview with Diana Isaacs, PharmD, with insights on disparities in diabetes care and quality considerations. Guidance is offered on improving CGM access as a means for meeting recent HEDIS quality measures tied to reducing emergency department and hospital use. Using findings from Blue Cross Blue Shield North Carolina as a case study, the infographic serves as a call-to-action for payers to remove manual prior authorizations for CGM under the pharmacy benefit.