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Medicare Coverage of Continuous Glucose Monitors Sought

by The O&P EDGE
March 17, 2015
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Even though an estimated 3 million Americans are living with type 1 diabetes and the Food and Drug Administration (FDA) has approved the use of continuous glucose monitors (CGMs) for patients with diabetes, Medicare will not provide coverage for these devices, which could save lives and prevent serious complications from the disease.

During a recent hearing of the Senate Health, Education, Labor and Pensions (HELP) Committee, Sen. Susan Collins said, “Continuous glucose monitors are helping patients control their blood glucose levels, which is key to preventing costly and sometimes deadly complications from diabetes.” Noting that the FDA and the National Institutes of Health (NIH) have been extremely supportive of advancements in technology like CGMs, she said that she was therefore “surprised and troubled” that the Centers for Medicare & Medicaid Services (CMS) will not cover these devices for Medicare beneficiaries. Since private insurance generally covers the cost of CGMs, she said, many seniors suddenly lose this important coverage when they become eligible for Medicare.

“Life is very difficult for people with diabetes, and anything to make life easier and healthier is welcomed,” said Deb Shuck. Shuck is an above-knee amputee who has type 1 diabetes. “Diabetes is the leading cause of blindness, and these people making decisions to cut off CGM systems are blind themselves to the fact that maintenance of good care is paramount to keep people with diabetes healthy. Being an insulin pump user, I have no choice but to pay out-of-pocket for these strips, making my pockets that much lighter. It is vital to the care of those with diabetes everywhere to maintain their health and welfare.”

Collins will soon be reintroducing the “Medicare CGM Access Act,” which would require Medicare to cover the device for individuals meeting specified medical criteria.

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