Medicare Massively Expands CGM Coverage for People with Type 2 Diabetes

If you’re on Medicare and you use basal insulin to manage your diabetes, you’re now eligible for a continuous glucose monitor (CGM).

The change took place on April 16, 2023, and the result is significantly expanded access to CGMs for people with type 2 diabetes.

Previously, coverage was mostly limited to people with type 2 diabetes that employed rapid-acting insulin before meals in an intensive insulin management strategy. Now, however, those who use only basal insulin — one or two daily shots of a long-acting insulin such as Lantus — can also get their hands on the game-changing technology.

Medicare is also expanding CGM access to some individuals that do not use insulin but have a history of “problematic hypoglycemia.” Some of the adults that find themselves in this category may be users of sulfonylureas, a popular class of diabetes drugs that stimulate insulin production and can therefore cause dangerously low blood sugar levels.

Dexcom and Abbott Laboratories, the manufacturers of the two most popular CGM systems, report that the change could bring CGM technology to as many as 1.5-2 million people. And there may eventually be knock-on effects that help bring access to more Americans — private insurers often look to Medicare to decide which medicines and devices to cover.

The change was cheered across the diabetes community.

“We applaud Medicare’s decision allowing for all insulin-dependent people as well as others who have a history of problematic hypoglycemia to have access to a continuous glucose monitor, a potentially life-saving tool for diabetes management,” said Chuck Henderson, CEO of the American Diabetes Association.

Many experts believe that CGM technology should be available to everyone with diabetes, regardless of their insulin use or risk of hypoglycemia. Initially, the CGM was mostly limited to people with type 1 diabetes, a condition that entails a very high risk of life-threatening hypoglycemia. CGMs can sense low blood sugar and sound an alarm, alerting the user to take action. It’s a feature that can save lives, but people with 2 diabetes tend to have less need for such alarms, especially if they’re not using rapid insulin before meals.

Even people with no serious risk of hypoglycemia, however, can benefit hugely from CGM technology. Thomas Grace, MD, the medical director of Ohio’s Blanchard Valley Diabetes Center, told Diabetes Daily that CGM is extremely valuable as a “lifestyle modification tool.” People using the device “learn about what they’re eating, they learn what happens when they take their medications, they learn the benefits of physical activity.”

Dexcom, whose G7 will be covered under the updated Centers for Medicare & Medicaid Service (CMS) policy, helped fund the MOBILE Study, which provided some of the data that was instrumental in CMS’ decision. That trial showed that CGM use significantly improves A1C and increases time in range for adults with Type 2 diabetes on basal insulin. The improvements, in fact, are on par with those of adults that use intensive insulin management.

“This is a major win for the diabetes community, and another validation of how CGM can benefit all people living with diabetes,” said Thomas Martens, MD, in a Dexcom press release. Dr. Martens was the lead investigator of the MOBILE study and is the medical director of Minneapolis’ International Diabetes Center.

Martens stated: “The evidence is clear: Real-time CGM use helps people with diabetes on all types of insulin, not just mealtime insulin, achieve better glycemic outcomes.”

Abbott Laboratories, the manufacturer of the popular FreeStyle Libre CGM system, also celebrated the change. Jared Watkin, senior vice president for Abbott’s diabetes care business, called it a “monumental step.” The new coverage will apply to the FreeStyle Libre 2 system and the FreeStyle Libre 14 day system, but the business’ newest model, the Libre 3, is not yet eligible for coverage.

Both businesses also pointed out that the move should help to address racial and socioeconomic inequities in diabetes complications. Several studies, including a special survey commissioned by Diabetes Daily, have shown that minorities in the United States tend to have lesser access to the best diabetes technology. Coverage across the board for Medicare recipients might help bridge some of the gaps.

Both major CGM makers have set up websites to help patients on Medicare learn about and order their products:

Dexcom for Medicare Users

FreeStyle Libre for Medicare Users

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