Increase Access, Reduce Disparities: Recommendations for Modifying Medicaid CGM Coverage Eligibility Criteria

Rodolfo J. Galindo, Grazia Aleppo, Christopher G. Parkin*, David A. Baidal, Anders L. Carlson, Eda Cengiz, Gregory P. Forlenza, Davida F. Kruger, Carol Levy, Janet B. McGill, Guillermo E. Umpierrez

*Corresponding author for this work

Research output: Contribution to journalComment/debatepeer-review

5 Scopus citations

Abstract

Numerous studies have demonstrated the clinical value of continuous glucose monitoring (CGM) in type 1 diabetes (T1D) and type 2 diabetes (T2D) populations. However, the eligibility criteria for CGM coverage required by the Centers for Medicare & Medicaid Services (CMS) ignore the conclusive evidence that supports CGM use in various diabetes populations that are currently deemed ineligible. In an earlier article, we discussed the limitations and inconsistencies of the agency’s CGM eligibility criteria relative to current scientific evidence and proposed practice solutions to address this issue and improve the safety and care of Medicare beneficiaries with diabetes. Although Medicaid is administered through CMS, there is no consistent Medicaid policy for CGM coverage in the United States. This article presents a rationale for modifying and standardizing Medicaid CGM coverage eligibility across the United States.

Original languageEnglish (US)
Pages (from-to)974-987
Number of pages14
JournalJournal of Diabetes Science and Technology
Volume18
Issue number4
DOIs
StatePublished - Jul 2024

Funding

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: R.J.G. is supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health (NIH) under award numbers 2P30DK1110246 and K23DK123384-3. R.J.G. received research support to Emory University for investigator-initiated studies from Novo Nordisk, Dexcom, and Eli-Lilly and consulting fees from Sanofi, Eli-Lilly, Boehringer, Pfizer, and Weight Watchers, outside of this work. G.A. has received research support to Northwestern University from Astra Zeneca, Dexcom, Eli-Lilly, Emmes, Fractyl Health, Insulet, Novo Nordisk, and WellDoc. G.A. has received consulting fees from Eli-Lilly, Dexcom, and Insulet outside of this work. C.G.P. has received consulting fees from Abbott Diabetes Care, CeQur, Dexcom, LifeScan, Mannkind, Roche Diabetes Care, and ProventionBio. D.A.B. has no disclosures associated with this manuscript. A.L.C. has received research support from UnitedHealthcare, Abbott, Dexcom, Eli-Lilly, Insulet, Medtronic, Novo Nordisk, and Sanofi, and is a consultant for Medtronic and Insulet, with all financial support going to his institution. In addition, ALC has a patent, Treatment of Hypoglycemia Unawareness with Intranasal Insulin, pending to HealthPartners Institute. EC is a scientific advisor for Eli-Lilly, Novo Nordisk, Adocia, and Arecor. G.P.F. received research support from Medtronic, Dexcom, Abbott, Tandem, Insulet, Beta Bionics, and Lilly, and has served as a consultant, speaker, and advisory board member for Medtronic, Dexcom, Abbott, Tandem, Insulet, Beta Bionics, and Lilly. D.F.K. institution has received research support from NIH, Helmsley Foundation, Novo Nordisk, Abbott Diabetes, and Dexcom. D.F.K. has received consulting fees from Novo Nordisk, Abbott Diabetes, Mannkind, CeQur, Sanofi, Medical Module, ProventionBio, and Pendulum. D.F.K. is the speaker for Dexcom, Novo Nordisk, Sanofi-Aventis, Xeris, and CeQur. D.F.K. has stock options not redeemed in Pendulum. C.J.L. has received research support by the NIDDK and Helmsley Foundation and industry support paid to the Icahn School of Medicine at Mount Sinai from Abbott Diabetes, Dexcom, Insulet, Novo Nordisk, Senseonics, and Tandem. C.J.L. has received consulting fees from Eli-Lilly, and Dexcom outside of this work. J.B.M. has received research support from the NIH, Helmsley Foundation, JDRF, Novo Nordisk, and Beta Bionics. J.B.M. has received consulting fees from Bayer, Boehringer Ingelheim and Lilly, Mannkind, Novo Nordisk, and Thermo Fisher outside of this work. G.E.U. is partly supported by research grants from the National Institutes of Health (NIH/NATS UL 3UL1TR002378-05S2) from the Clinical and Translational Science Award program, and from National Institutes of Health and National Center for Research Resources (NIH/NIDDK 2P30DK111024-06). G.E.U. has received research support (to Emory University) from Astra Zeneca, Bayer, Abbott, and Dexcom. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Abbott Diabetes Care provided funding for editorial assistance in developing this article.

Keywords

  • Medicaid
  • continuous glucose monitoring
  • insulin
  • type 1 diabetes
  • type 2 diabetes

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Bioengineering
  • Biomedical Engineering

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