Great news for people with diabetes on the what's-covered-by insurance-front: Medicare is now covering certain glucose monitors and also allowing beneficiaries to use smartphone apps in conjunction with their covered CGMs.
Yep, the word "also" refers to a key point that's been more than a year in the making. A long-awaited policy change by the Centers for Medicare and Medicaid Services (CMS) on Monday makes it official, that the wireless phone connectivity of new CGM systems is included in what Medicare covers, which was previously not the case.
How Has Medicare Traditionally Covered CGM?
The federal agency first stated in January 2017 that it would allow coverage of CGMs systems for its beneficiaries (see details here).
For years prior, CMS had viewed these devices as "adjunctive," or supplemental versus being medically necessary for diabetes management, because patients were supposed to rely on fingerstick calibrations before making any treatment decisions.
It took years of advocacy and grassroots #MedicareCoverCGM campaigns, but once the FDA designated the Dexcom G5 Mobile system good enough to dose insulin and make treatment decisions without any fingerstick calibrations being required, that paved the way for Medicare CGM coverage.
Medicare policy-makers determined that certain CGMs should be covered for all types of diabetes, as long as they're proven accurate enough to make treatment decisions without calibrations. These so-called "thereapeutic CGMs" currently include the Dexcom G5, the newly-launched Dexcom G6, and the Abbott Freestyle Libre; Medtronic has not pursued this designate to date.
Unfortunately, that Medicare policy change didn't go far enough:
- Medicare wouldn't allow for smartphone app use -- a key feature for CGM users (especially those on Dexcom's G5) who need to share data with loved ones or clinicians. Ironically, this type of data sharing is an important aspect for many older PWDs on Medicare, since it allows remote monitoring of their well-being with diabetes.
- Why, you ask? The federal agency followed a strict defininition of what's classified as Durable Medical Equipment (DME), and as a result saw the handheld CGM receiver as an essential part of the system. Use without the receiver, like just a using smartphone app, would negate their coverage policy. Some also wondered if there might be concerns that Medicare beneficiaries would start requesting coverage for smartphones, if these connected mobile apps were allowed to be used with the covered CGMs.
- In short, Medicare wouldn't cover CGM for anyone using these CGM apps, and forced Dexcom to abide by that rule, shipping out receiver units to anyone ordering their product, whether the customer planned to use it or not. Dexcom also tracked who connected to its CGM server in the cloud, flagging those Medicare folk who might try to use the mobile apps.
Because of this head-scratching gap, many in the D-Community felt cheated and basically "stuck in the middle" of this Medicare policy anomaly.
Consumer Pressure on CMS
After more than a year of advocacy pushing CMS to understand the shortcomings of that policy decision, the agency has now revised its stance and will allow for Medicare beneficiaries to use the smartphone apps paired with their CGM.
In its policy note published on the DME site, Medicare officials wrote:
"CMS heard from numerous stakeholders who shared their concerns that Medicare’s CGM coverage policy limited their use of CGMs in conjunction with their smartphones, preventing them from sharing data with family members, physicians, and caregivers. After a thorough review of the law and our regulations, CMS is announcing that Medicare’s published coverage policy for CGMs will be modified to support the use of CGMs in conjunction with a smartphone, including the important data-sharing function they provide for patients and their families."
From what CMS Administrator Seema Verma tweeted at the time of this announcement, we're even more impressed by this policy revision:
This decision came less than a week after a key advocacy meeting with CMS on June 6, in which various diabetes groups met with CMS officials to share patient stories and push the agency to make this change. Those orgs included the American Association of Clinical Endocrinologists (AACE), American Association of Diabetes Educators (AADE), the Endocrine Society, and the Diabetes Patient Advocacy Coalition (DPAC).
According to Christel Aprigliano who leads DPAC, this policy change is a direct result of the community's efforts: More than 2,700 messages were sent to Congress and CMS via the DPAC web platform alone, not to mention all the calls and letters and other social media calls to action from the D-Community.
Dexcom echoed that sentiment in its official press release, with a quote from Senior VP of Global Access, Claudia Graham (who lives with T1D herself):
“We would also like to recognize the diabetes community for their efforts in voicing the necessity for this change. CMS listened and recognized the need to allow the sharing of glucose data in this population."
As to when this actually takes effect, that's TBD.
The task of "rolling out" the new policy falls to the a group of Durable Medical Equipment Medicare Administrative Contractors, who need to issue a revised policy article. Advocates familiar with this issue believe it will likely happen in the coming weeks.
The Diabetes Community Responds
Across the D-Community, people are responding with joy to this news, knowing that it sets the stage for full coverage of connected data-driven diabetes tools.
For example, Laddie Lindahl from Minnesota, who entered the Medicare arena in just the past few years and has been worried about her inability to use CGM data-sharing apps when that time comes.
"I am thrilled," she says. "Although I do not require monitoring by a friend or family member at this time, I know that could change in a minute. I appreciate knowing that soon I will have access to Dexcom Follow features and that those people who desperately and currently need BG monitoring will be safer. I'm pleased that Medicare beneficiaries with vision problems and other disabilities will be able to use the accessibility features of their smartphones to access their CGM data and alerts."
Now, Laddie hopes the Medicare ruling will be interpreted to allow for her Tandem t:slim X2 insulin pump to be used instead of her Dexcom CGM receiver as well.
"I am grateful for not being abandoned by Dexcom and for the advocacy of DPAC and the entire diabetes community," she adds.
Likewise fellow T1D peep Susan Mustian in Kentucky is excited to hear about this long-awaited Medicare policy change. While she's not on Medicare at the moment being 55 years old (and T1D for 32 years), she has a neighbor and close friend named Frank who's 67 years old and lives with type 2, and has experienced this issue firsthand.
"I’ve been talking to my friend for a year about getting the Dexcom, and last week I helped him insert and start on that," she said. "He told me, and Dexcom confirmed, that he could not use the iPhone features even with his wife worried about not being allowed to follow him. This is great news for my T2D friend. I know the Dexcom Share app used by my family has saved me from a life-threatening Low and now I'm relieved it can help him too!"
Like others in our D-Community, we're very proud to see this collective effort lead to national policy change. Access is so hugely important, and it's good to know that Medicare is taking steps in the right direction to make sure all people with diabetes have access to the most advanced tools.