Stakeholders push two-channel option for CGMs

WASHINGTON – Users of continuous glucose monitors have reported difficulties obtaining equipment and supplies when their insurers eliminate coverage under DME, adding more evidence that there needs to be a two-channel option, stakeholders say. 

As CMS has expanded coverage of CGMs and supplies, some payers have begun making it a pharmacy-only benefit, limiting brand choices and narrowing networks. 

“One patient wrote that they attempted to obtain sensors from three different local pharmacies who did not carry CGMs and had no plans to and they were even unable to get service from the preferred pharmacy their insurance recommended,” said David Chandler, vice president of payer relations for AAHomecare. 

AAHomecare in September launched a portal to collect end user and family caregiver stories about the impact of policy changes for CGMs, with the goal of educating payers and governmental agencies on access issues and proposed solutions.   

Also in September, CCS published the findings of a peer-reviewed study that found individuals with diabetes who receive their CGMs under the DME benefit have a 23% higher adherence rate than pharmacy patients, while pharmacy patients incur costs that are, on average, 53% higher. 

It’s been the focus of conversations within the AAHomecare Diabetes Council for the past year, says Linda Langiotti, chairwoman of the council and senior vice president of strategic channels for CCS.  

“We do believe the DME channel should always remain a choice,” she said. “We're doing much more than just getting them products. We're educating them, we're troubleshooting with them, we're reaching out for their physician when we need to get new prescriptions. We're doing all these things on behalf of these patients to help them stay on therapy and I think every DME within the space should be speaking to their payer community and reiterating the value of DME on every conversation.”