New, expanded coverage of continuous glucose monitors (CGMs) under Medicare go into effect in April.
CMS first published the LCD modifying coverage criteria for CGMs in October. The modification includes people with diabetes who receive insulin treatment or have a history of problematic hypoglycemia. The proposal eliminates the requirement for frequent adjustments of the patient’s insulin treatment regimen. This falls on the basis of glucose measurement testing.
The finalized version changed some language on the criteria. It amended the line saying “the beneficiary is insulin-treated with at least one daily administration of insulin” to, simply, “the beneficiary is insulin-treated.” According to BTIG analyst Marie Thibault, the decision increases access for approximately 1.5 million people using basal-only treatment in the U.S. covered by Medicare. That could expand to between 3 million and 4 million, she said, as U.S. commercial payors follow suit.
“In our view, this is a significant catalyst that will increase CGM adoption in this patient population, benefiting both Abbott and [Dexcom],” Thibault wrote.
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