CGM Medicare Coverage

One Voice Calling for Medicare Coverage of Continuous Glucose Monitors (CGMs)

We need your help. Ask the U.S. Senate and House of Representatives to co-sponsor bipartisan bills to ensure people over 65, and who are Medicare-eligible, have access to life-saving CGMs!

The Co-Chairs of the Senate Diabetes Caucus have introduced important bipartisan legislation (S. 804) — the ‘Medicare CGM Access Act of 2015’ — that would facilitate Medicare coverage for continuous glucose monitors (CGMs) and help pave the way for the next generation of CGM-related technologies, such as artificial pancreas (AP) systems.

This legislation joins a bipartisan companion bill, (H.R. 1427), introduced in the U.S. House by the Leadership of the Congressional Diabetes Caucus.

But we still need your help! Please take a few minutes to:

  1. Email your Representative and ask him/her to support H.R. 1427, the ‘Medicare CGM Access Act of 2015’
  2. Email your Senators and ask that they support S. 804, the ‘Medicare CGM Access Act of 2015’

After you complete these two simple action steps, please ask your friends, family, neighbors and coworkers to do the same! And spread the word on your favorite social media pages using the hashtag #MedicareCoverCGM.

CGMs have a medical purpose, and should be covered by Medicare

CGMs are U.S. Food & Drug Administration (FDA)-approved, physician-prescribed devices that detect and display blood-glucose levels continuously—and reveal trends in these levels that often go unnoticed. A JDRF-funded CGM trial has shown that the rate of severe high blood-sugar (hyperglycemia) events among adults using a CGM fell by two-thirds over the first year of use. Not surprisingly, CGMs are recommended by national diabetes clinical guidelines — and they’re covered by nearly all private health plans.

Unfortunately, Medicare does not currently cover CGMs — despite the evidence of clinical benefit. The result? Millions of seniors with diabetes are left vulnerable to severe low blood-sugar (hypoglycemia) events that can lead to seizures, bouts of unconsciousness and hospitalization. And the costs are not just physical:

  • Hypoglycemia inpatient admission rates are an average of $17,564 per visit.
  • Diabetes is one of the costliest chronic diseases, accounting for $245 billion in economic losses in 2012, including $176 billion in direct medical costs.
  • Of that $176 billion, 59 percent is attributed to those ages 65 and older.
  • Overall, 42 percent of Medicare fee-for-service spending is attributed to people with diabetes.

The agency responsible for Medicare has said CGMs have no “medical purpose” because people use them in addition to blood glucose meters. JDRF disagrees — CGMs have a clear medical purpose. CGMs improve diabetes clinical outcomes, according to numerous studies, and they are also recommended by all diabetes clinical guidelines. Moreover, CGMs are already being used to make diabetes treatment decisions, and, as JDRF recently argued before the FDA, the CGM indication should be updated to reflect its use.

Please take action today!

JDRF has been working closely with other interested stakeholders to encourage Medicare to cover CGM devices — and we have made it one of our top national advocacy priorities. While we continue to work to resolve this issue quickly, we need your help to build support within Congress.

Remember, all you have to do is:

  1. Ask the U.S. House to co-sponsor H.R. 1427
  2. Ask the U.S. Senate to co-sponsor S. 804

If you haven’t already, please sign-up to be a JDRF Advocate. Your voice will help us make a difference in the fight to help us turn Type One into Type None.