BCBSMA Coverage For Continuous Glucose Monitors
posted: June 17, 2019
Bruce Nash MD, MBA
Chief Physician Executive
Blue Cross Blue Shield of Massachusetts
101 Huntington Avenue, Suite 1300
Boston, MA. 02199-7611
RE: BCBSMA coverage for continuous glucose monitors
Dear Dr. Nash,
The New England Chapter of the American Association of Clinical Endocrinologists (NE AACE) is committed to providing the best possible care to our patients with diabetes and other endocrine conditions. We treat many patients with Type 1 diabetes or insulin-requiring Type 2 diabetes who utilize continuous glucose monitors (CGM) for their diabetes management.
CGM decreases risks of severe hypoglycemia as well as hyperglycemia, but also helps change behaviors in patient adherence to treatment goals and safety. We prescribe CGM especially for patients who are at risk for severe hypoglycemia or have hypoglycemia unawareness.
Currently, the medical policy of BCBSMA states CGM coverage may be considered medically necessary under three situations — Inadequately controlled Type 1 diabetes (A1c >7.5%); Patients with Type 1 diabetes who experience recurrent, unexplained, severe hypoglycemia or have impaired awareness of hypoglycemia; Patients with poorly controlled Type 1 diabetes who are pregnant.
However, there have been a number of recent articles (1-5) that document significant benefit in patients with insulin-requiring Type 2 diabetes. At present time, Medicare coverage for CGM is approved if patient is taking 3 or more insulin injections daily or using an insulin pump and testing 4 or more times daily for 4 weeks prior to approval. Medicare coverage for CGM is approved whether patient has Type 1 diabetes or insulin requiring Type 2 diabetes.
On behalf of the New England Chapter of the American Association of Clinical Endocrinologists, we respectfully request that you allow type 2 diabetes patients on multiple daily insulin injections or on insulin pump therapy, as defined by Medicare guidelines, to be approved for CGM coverage.
Barry Izenstein, MD, FACP
President, New England AACE
New England AACE Socioeconomic Committee: Miguel A. Ariza, MD, ECNU, Richard Haas, MD, FACE William Sullivan, MD, FACP, FACE
- Beck RW, Riddlesworth TD, Ruedy K, et al.; DIAMOND Study Group. Continuous glucose monitoring versus usual care in patients with type 2 diabetes receiving multiple daily insulin injections: a randomized trial. Ann Intern Med 2017;167:365–374
- Ehrhardt NM, Chellappa M, Walker MS, Fonda SJ, Vigersky RA. The effect of real-time continuous glucose monitoring on glycemic control in patients with type 2 diabetes mellitus. J Diabetes Sci Technol 2011;5:668–675
- Haak T, Hanaire H, Ajjan R, Hermanns N, Riveline J-P, Rayman G. Flash glucose-sensing technology as a replacement for blood glucose monitoring for the management of insulin-treated type 2 diabetes: a multicenter, open-label randomized controlled trial. Diabetes Ther 2017;8:55–73
- Yoo HJ, An HG, Park SY, et al. Use of a real time continuous glucose monitoring system as a motivational device for poorly controlled type 2 diabetes. Diabetes Res Clin Pract 2008;82:73–79
- Alan J. Garber, Martin J. Abrahamson, Joshua I. Barzilay, Lawrence Blonde, Zachary T. Bloomgarden, Michael A. Bush, Samuel Dagogo-Jack, Ralph A. DeFronzo, Daniel Einhorn, Vivian A. Fonseca, Jeffrey R. Garber, W. Timothy Garvey, George Grunberger, Yehuda Handelsman, Irl B. Hirsch, Paul S. Jellinger, Janet B. McGill, Jeffrey I. Mechanick, Paul D. Rosenblit, and Guillermo E. Umpierrez (2019) CONSENSUS STATEMENT BY THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY ON THE COMPREHENSIVE TYPE 2 DIABETES MANAGEMENT ALGORITHM — 2019 EXECUTIVE SUMMARY. Endocrine Practice: January 2019, Vol. 25, No. 1, pp. 69-100.