CGM Medicare Coverage

One Voice Working to Ensure Medicare Coverage of Continuous Glucose Monitors (CGMs)

Thanks to extensive advocacy by JDRF volunteers and staff, clinician support, and strong bipartisan support from Congress, the Centers for Medicare & Medicaid Services (CMS) determined recently that continuous glucose monitoring (CGM) devices that are approved for use in treatment decisions are eligible for Medicare coverage. (For more information, please see our JDRF blog and press release.) This decision is a victory for people with type 1 diabetes (T1D) who are on Medicare or will be aging into Medicare. It is also a victory for the entire T1D community as broader coverage creates an incentive for innovation.

On behalf of JDRF and all those affected by T1D, we ask that you please take a moment to thank your U.S. Senators and also thank your U.S. Representative for their timely work on this issue. For a couple of years, the leadership of the Senate Diabetes Caucus and the Congressional Diabetes Caucus has been working tirelessly to ensure Medicare coverage of CGMs, which are currently covered by more than 95 percent of private health plans. These Members of Congress and their colleagues deserve our recognition and our appreciation for co-sponsoring the ‘Medicare CGM Access Act of 2015’ (S. 804 and H.R. 1427), as introduced by Senators Collins and Shaheen, and Representatives Reed and DeGette. A successful 2016 ended with 50 Senators on the Senate bill and 275 Representatives on the House companion version. Congress will not need to reintroduce and enact legislation now that there is finally a favorable Medicare coverage decision.

CGMs have a medical purpose, and have been recognized as such 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 by using finger sticks alone. The Centers for Medicare and Medicaid Services had decided previously that CGMs have no “medical purpose” because people use them in addition to blood glucose meters. The broader T1D community disagreed, and spoke up in large numbers—CGMs have a clear medical purpose. CGMs improve diabetes clinical outcomes, according to numerous studies, including a JDRF-funded CGM trial that shows 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. Moreover, CGMs are already being used to make diabetes treatment decisions, and, as JDRF argued before the FDA last year, the CGM indication should be updated to reflect its use.

JDRF worked closely with other interested stakeholders to encourage Medicare to cover CGM devices — and it remained one of our top national advocacy priorities. We are pleased that the agency delivered this good news to people with type 1 who are on Medicare, or will be aging into Medicare, and also set the stage for future innovation in this space due to the broader coverage this decision creates.

Please take action today!

We have much left to do, so please take a moment and thank your Members of Congress in the Senate and in the House who supported this effort. Also, if you know of others who are not yet JDRF Advocates, please share this good news and ask them to sign up to be advocates, too. To participate in the discussion taking place on social media communities, use the hashtag #MedicareCoverCGM.

Your voice will help us make a difference in the fight to help us turn Type One into Type None.