ManagedCareCGM

This site is intended for managed care professionals in the U.S.

This site is intended for managed care professionals in the U.S.

Professionals in Canada should visit CanadaCGM.com

Continuous Glucose Monitoring

Education for Managed Care, Pharmacy, and Payer Professionals

Featured Resources

Search
Generic filters

Payer Perspectives on the Value of Real-Time Continuous Glucose Monitoring

A panel of distinguished faculty including both expert clinicians and healthcare decision makers was convened to discuss recent studies on the value of real-time CGM (rtCGM) in type 2 diabetes (T2D). This summary illustrates the key findings from these studies as seen by the faculty, including:

  • Early improvement in HbA1c results in a legacy effect reducing the long-term complications of diabetes
  • Recent studies published in JAMA demonstrate the value of rtCGM for improving glycemic control and reducing resource utilization in insulin-treated T2D across both a randomized, controlled trial (RCT) and a real-world cohort analysis
  • Prospective and retrospective analyses reinforce average cost-savings of $400 per member per month (PMPM) or greater associated with rtCGM and demonstrate the value derived through appropriate coverage and patient selection
  • Increasing access to rtCGM is one potential means of combatting health disparities
  • Pharmacy coverage of rtCGM can elicit immediate cost-savings for payers in addition to easing the administrative burden on both payers and providers while enhancing access among members

Click here to download the summary.

 


Lower A1c and Reduce Hospital/ED Use in Members with Insulin-Treated Type 2 Diabetes via Real-Time Continuous Glucose Monitoring

Released: September, 2021

 

 

Click here to view the infographic

 


Optimize Outcomes in Insulin-Treated T1 and T2D via Evidence-Based Coverage Criteria with Real-Time Continuous Glucose Monitoring

Released: June, 2021

 

Click here to view the infographic


Improving Quality Metrics and Reducing Cost of Care with Access to Real-Time Continuous Glucose Monitoring

Source: Improving Quality Metrics and Reducing Cost of Care with Access to Real-Time Continuous Glucose Monitoringa symposium at the Academy of Managed Care Pharmacy 2021 Virtual Annual Meeting.

Featuring expert faculty:

Jeffrey Dunn, PharmD, MBA
Head of Clinical Pharmacy
Berkshire Hathaway/Geico
(Formerly) Vice President, Clinical Strategy and Programs and Industry Relations
Magellan Rx Management

Maria Lopes, MD, MS
Former Chief Medical Officer
Magellan Health
Former Practicing Obstetrician and Gynecologist

Janet B. McGill, MD, MA, FACE, FACP
Professor of Medicine
Washington University School of Medicine

Vanita Pindolia, PharmD, BCPS, MBA
Vice President, Ambulatory Clinical Pharmacy Programs_PCM
Henry Ford Health System/Health Alliance Plan of Michigan

Key Takeaways: 

  • All insulin treated members,  particularly high-risk older adults, should have streamlined access to real-time CGM, and payers should reconsider coverage criteria, such as removing intensive insulin eligibility criteria for T2D and streamlining the documentation requirements.
  • Pharmacy coverage and access for appropriate subpopulations can confer immediate cost savings.
  • Consensus guidelines recommend the use of rtCGM in pregnant women with pre-existing T1 and T2D and GDM. A delay in access to CGM can have adverse consequences in terms of both maternal and neonatal outcomes.
  • rtCGM allows for a new frontier of diabetes management through remote monitoring and innovative patient engagement in telemedicine initiatives.

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


Leveraging Diabetes Health Technology in Managed Care and Coverage Considerations for Real-Time Continuous Glucose Monitoring

Announcing a new white paper based on key findings from the Therapeutic CGM Health Care Stakeholder Summit held on November 7, 2019, in Washington, DC. The stakeholder panel included payer and employer leadership along with clinical experts in the field of endocrinology. The purpose was to gather input pertinent to the coverage and application of therapeutic continuous glucose monitoring (CGM) in managed care settings. Clinical evidence supporting the clinical and economic value of rtCGM was presented and the insights of these health care stakeholders were captured en route to formulating coverage policy recommendations for the future. This input is intended to advance the uptake and appropriate coverage of evidence-based health technology interventions by managed care organizations (MCOs) and various payers.

Click here to download the white paper.

Click here to download the white paper in black and white.