Getting CGM Covered by Medicare Still on the Agenda

The 113th Congress adjourned without passing an important agenda item of diabetes advocacy groups: getting Medicare to cover continuous glucose monitors, or CGM technology. Yet supporters of this policy change, especially the Juvenile Diabetes Research Foundation (JDRF), are hopeful that the legislation will pass in the session that starts next week, based on the support the measure received, despite being advanced late in the last session.

JDRF has taken lead to address a problem that has grown worse each year, as more persons with type 1 diabetes mellitus (T1DM) live to retirement and rely on Medicare for their health coverage. After years of living full lives, thanks to improving technology often covered by commercial insurance, they find that Medicare will not cover the devices that have given them the ability to monitor their blood sugar in real time.

After years of being accustomed to finely tuned adjustments to insulin intake that prevented episodes of hypoglycemia or hyperglycemia, seniors who retire often lose access to CGM technology, only to see their hospitalization rates rise, and some approaching retirement live in fear of what is to come.

The legislation had a lot working against it. First, it was a spending measure, and it was never scored by the Congressional Budget Office. Second, it was not introduced until the summer, when every member of the House of Representatives and a third of the Senate was busy campaigning for re-election. Yet, as JDRF’s Christopher Rucas noted shortly after Congress adjourned, it still gained 41 co-sponsors in the House (19 Republicans and 22 Democrats) and 16 in the Senate (6 Republicans and 10 Democrats).

“Our champions in the House and Senate will reintroduce the Medicare CGM Access Act when the new Congress convenes in January,” Mr Rucas said.

The bipartisan support bodes well for the ability of the JDRF and other diabetes advocates to eventually gain coverage for CGM. The chief reason for the late introduction is that groups had been working with CMS on an administrative solution for Medicare coverage, and the legislative route was taken after those efforts stalled. Published reports in online resources for persons with diabetes, such as DiabetesMine, recount unsuccessful efforts to convince CMS officials that CGM technology is not simply more convenient; it’s essential for patient safety.

Mr Rucas said as 2015 begins, JDRF will pursue both legislative and administrative strategies to get CGM technology broadly covered by Medicare for seniors with T1DM.

Advocates frequently cite a 2011 study from The American Journal of Managed Care in making their case. That study found that every incident of hypoglycemia that results in a trip to the emergency department costs $17,564, and many of these incidents could be avoided with more widespread use of CGM technology.

Around the Web

Don’t Take Away My Access to Life Saving Diabetes Technologies

Call to Action on CGM Access for Medicare

The Incidence and Costs of Hypoglycemia in Type 2 Diabetes