Medicare Coverage for Continuous Glucose Monitors
Until about a year ago, people with diabetes who used a continuous glucose monitor (CGM) lost coverage once they went on Medicare. For those diagnosed after they went on Medicare, a CGM wasn’t an option. The only solution? Pay for the device out of pocket or don’t use one at all.
Now, two CGM systems—Dexcom’s G5 Mobile and Abbott’s FreeStyle Libre—are covered as durable medical equipment under Medicare Part B for beneficiaries with type 1 or type 2 diabetes who take multiple daily insulin doses and who make frequent adjustments to those doses.
The Dexcom G5 Mobile—like most other CGMs—consists of three parts. A sensor is inserted just under the skin, continuously monitoring glucose for up to a week; a transmitter attaches to the sensor and sends readings to a receiver or insulin pump; and a wireless receiver, smartphone, or pump displays the glucose readings. The system tells users whether their glucose levels are steady, rising, or falling—and how quickly. It also alerts users when their level rises too high or drops too low. (Those values are determined by the user, with help from a doctor, and are programmed into the system.)
The FreeStyle Libre works in a slightly different way. A sensor, worn on the upper arm for up to 10 days, collects glucose data from just below the skin. Users move a reader device, which looks like a large glucose meter, over the sensor to check their glucose level. Like traditional CGMs, the FreeStyle Libre displays whether a person’s glucose is rising, falling, or staying steady, but the device doesn’t deliver alerts when levels go out of range. On the upside, the FreeStyle Libre doesn’t require calibrations using finger-stick values, whereas other CGMs currently do.
Several studies have shown that using a CGM can help people with diabetes improve their glucose management to a greater extent than is possible with periodic finger-stick checks, says endocrinologist and diabetes technology expert David Ahn, MD, of the University of California–Los Angeles. “Comparing finger sticks to CGM is like comparing a photo album to video footage of an event,” Ahn says. “Continuous glucose monitoring allows users to visualize their sugars nearly in real time. By seeing the immediate impact on blood sugar of exercise, meals, stress, medications, and sleep, users can learn about their bodies and be empowered in a way unlike anything finger sticks can offer.”
One and All
The agency that oversees Medicare decided to cover Dexcom’s G5 Mobile and Abbott’s FreeStyle Libre because both are approved by the Food and Drug Administration (FDA) for “nonadjunctive” use. That means people wearing the system can use the glucose values displayed on the devices to make decisions about insulin dosing without having to perform a finger-stick check to confirm the number.
In addition, Medicare ruled last year that therapeutic CGM systems—those that provide information that can be used to make treatment decisions—could be covered as necessary durable medical equipment (the same category of coverage that includes blood glucose meters) because they meet all of Medicare’s coverage criteria.
Medicare doesn’t cover nontherapeutic CGMs, such as Medtronic’s continuous glucose monitoring devices. At press time, Medtronic was working to obtain Medicare coverage for its CGMs.
If you use the Dexcom G5 Mobile CGM, take note: Medicare coverage comes with conditions. The continuous glucose monitoring system gives users the option of receiving glucose data on a handheld receiver or smartphone app. But as of press time, Medicare doesn’t cover the G5 Mobile if people use the smartphone app, even if they also use the separate receiver device. (It’s unclear how Medicare would know if a person used the phone app.) Mobile devices aren’t covered by Medicare, so CGMs used with a mobile app aren’t covered either.
One major downside is that without the smartphone app, users are unable to use the Share app, which allows remote users to follow the wearer’s glucose levels. This may cause particular problems for seniors, who are prone to dangerous low blood glucose (hypoglycemia) and would benefit from having a caregiver remotely monitor their glucose levels. “Restricting smartphone integration is absolutely ridiculous,” says Ahn. But he says that Medicare coverage for CGMs in general is “a huge win overall.”
Dexcom is in talks with Medicare to try to work things out, at least in the case of the Share function. Stay tuned.
For questions about Medicare coverage, call 800-MEDICARE (800-633-4227).
CGMs: Not Just for Pump Wearers
You don’t need to wear an insulin pump to benefit from continuous glucose monitoring (CGM). In two studies published in January 2017 involving a total of 319 people with type 1 diabetes on multiple daily injection therapy, using a CGM for six months resulted in better overall glucose levels and fewer episodes of low blood glucose compared with people who were told to perform at least four finger-stick blood glucose checks per day. This means that even without the fine-tuning that pumps allow, CGMs can provide information to help people adjust their injected doses to achieve better control.