As American Diabetes Month Starts, CMS Silent on What it Doesn't Cover: CGM

Today is November 1, the start of American Diabetes Month, an opportunity to raise awareness of the need for people who may have prediabetes to be screened, for those with the disease to learn more about self-care, and for those who don’t have diabetes to hear what it’s like to live with the disease 24/7.

Taken at face value, it might not seem a big deal for CMS to use the Medicare Blog as an opportunity to list the screening services, supplies, and training it covers. That’s what CMS did this morning, you can find the blog here.

Those who live with the disease, especially people with type 1 disease, know that the real story isn't in the blog post: Medicare does not cover continuous glucose monitoring (CGM), and it’s a big issue between the advocacy community and CMS.

CGM allows patients on intense insulin therapy to better monitor their blood sugar levels and make adjustments to insulin delivery or food intake before they experience an episode of hypoglycemia that requires hospitalization. Not only is the cost of CGM more than offset by medical savings, proponents say, but the control CGM affords also prevents disease progression and complications, such as kidney disease.

Groups like JDRF say CGM has proven its value, and advocates note that nearly all commercial payers cover it. Guidelines from the Americans Diabetes Association endorse CGM use—with adequate education, of course—as a way to promote successful blood sugar monitoring in patients who require intense insulin therapy.

Earlier this year, Evidence-Based Diabetes Management invited Senator Susan M. Collins, R-Maine, to write a commentary about this issue. Senator Collins noted that CMS’ position is out of step with FDA, which has approved the devices, and with the National Institutes of Health (NIH), which has supported the innovation that has improved the lives of people with diabetes.

Collins isn’t alone—legislation to compel Medicare to cover CGM enjoys bipartisan support in both the House and Senate.

So why doesn’t CMS cover CGM already? In December 2014, Dexcom CEO Terry Gregg said in an interview with Med Device Online that CMS would not cover the technology until device companies could obtain dosing claims for CGM; Gregg sounded hopeful that progress toward an algorithm for the artificial pancreas would bring companies toward this standard.

But JDRF and scores of other diabetes advocates say there’s plenty of evidence already that CGM prevents hospitalization and long-term costs. In his interview Gregg said that more and more seniors who have enjoyed years of good control with help from CGM face a return a lower standard of care when they retire and transition to Medicare.

Hospital visits are among the cost drivers behind the $245 annual cost of diabetes to the United States. In fact, the most-cited study on the $17,564 cost of a single inpatient admission due to hypoglycemia appeared in 2011 in The American Journal of Managed Care.