ManagedCareCGM

Continuous Glucose Monitoring

Education for Managed Care, Pharmacy, and Payer Professionals

Recent News

  • Effective July 1, 2020, NC Medicaid coverage of therapeutic Continuous Glucose Monitoring (CGM) products will transition from the Durable Medical Equipment (DME) Program to the Outpatient Pharmacy Point of Sale Program. The products will be included on the NC Medicaid and Health Choice Preferred Drug List (PDL). The PDL Preferred therapeutic CGM products will be the Dexcom G5 and G6.
  • Effective July 15, 2020, HCSC considers long-term continuous glucose monitoring of glucose levels in interstitial fluid medically necessary in patients with diabetes (Type 1 or Type 2 DM) who are willing and able to use the device, have adequate medical supervision, and are on multiple daily doses of insulin or an insulin pump. (Reference: Medical Policy Number DME101.005)

  • Effective April 1, 2020, Blue KC will also offer coverage for Continuous Glucose Monitors (CGMs) as a pharmacy benefit. While members can continue to utilize their DME benefits instead of pharmacy benefits for CGMs, some brands may eventually no longer be available through DME suppliers. Additionally, the process of obtaining a CGM through the pharmacy is likely a more timely, convenient, and overall better member experience.

  • Effective April 20, 2020 Aetna considers the long-term (greater than 1 week) therapeutic use of continuous glucose monitoring devices medically necessary in adults aged 18 years and older with type 1 diabetes, adults with type 2 diabetes using intensive insulin regimens (multiple (3 or more) daily injections or insulin pump therapy) who are not meeting glycemic targets, and for younger persons with type 1 diabetes.

  • Effective April 1st 2020  United Health Care covers long-term CGM for individuals with type 1 or type 2 diabetes when certain criteria are met.
  • Effective April 1, 2020, therapeutic continuous glucose monitors (CGMs) will be a benefit of Texas Medicaid for individuals with type 1 or type 2 diabetes who meet medical criteria.
  • Missouri Medicaid’s Pharmacy Program will begin covering the Dexcom G6 Continuous Glucose Monitoring (CGM) System as the preferred CGM system effective April 2, 2020.