Gravid news for people with diabetes connected the what's-mantled-by insurance-front: Medicare is now covering confident glucose monitors and also allowing beneficiaries to use smartphone apps in conjunction with their covered CGMs.

Yep, the word "also" refers to a identify point that's been more than a class in the making. A long-awaited about-face by the Centers for Medicare and Medicaid Services (CMS) on Monday makes it official, that the wireless earphone connectivity of new CGM systems is included in what Medicare covers, which was previously not the case.

How Has Medicare Traditionally Covered CGM?

The federal agency first stated in January 2017 that it would allow coverage of CGMs systems for its beneficiaries (imag details here).

For long time prior, CMS had viewed these devices as "adjunctive," or secondary versus being medically necessary for diabetes management, because patients were supposed to depend on fingerstick calibrations before making any treatment decisions.

It took years of advocacy and grassroots #MedicareCoverCGM campaigns, but once the Food and Drug Administration selected the Dexcom G5 Mobile system good enough to dose insulin and piddle treatment decisions without any fingerstick calibrations being required, that paved the way for Medicare CGM reportage.

Medicare policy-makers determined that predestined CGMs should be covered for all types of diabetes, As lengthened as they're tried accurate enough to nominate treatment decisions without calibrations. These so-called "thereapeutic CGMs" currently include the Dexcom G5, the newly-launched Dexcom G6, and the Abbott Freestyle Libre; Medtronic has not pursued this delegate up to now.

Unfortunately, that Medicare policy change didn't make it enough:

  • Medicare wouldn't allow smartphone app use — a key feature for CGM users (especially those on Dexcom's G5) who need to share data with loved ones Oregon clinicians. Ironically, this type of data sharing is an important aspect for many older PWDs on Medicare, since information technology allows remote monitoring of their well-organism with diabetes.
  • Why, you ask? The federal office followed a strict defininition of what's classified as Durable Medical Equipment (DME), and as a result saw the handheld CGM recipient Eastern Samoa an essential part of the system. Use without the receiver, like just a victimization smartphone app, would negate their coverage policy. Some also wondered if there mightiness be concerns that Medicare beneficiaries would start requesting reporting for smartphones, if these connected unsettled apps were allowed to make up used with the covered CGMs.
  • In small, Medicare wouldn't cover CGM for anyone using these CGM apps, and forced Dexcom to abide by that rule, transportation extinct receiver units to anyone ordination their ware, whether the customer planned to use information technology or not. Dexcom also tracked who neighboring to its CGM server in the cloud, tired those Medicare folk who power try to use the mobile apps.

Because of this head-scratching break, some in the D-Community mat up cheated and basically "stuck in the middle" of this Medicare policy anomalousness.

Consumer Pressure happening CMS

After more than a year of advocacy pushing CMS to understand the shortcomings of that insurance decision, the agency has now revised its stance and leave allow for Medicare beneficiaries to use the smartphone apps paired with their CGM.

In its insurance note published on the DME site, Medicare officials wrote:

"CMS heard from numerous stakeholders WHO shared their concerns that Medicare's CGM coverage insurance policy limited their use of CGMs in conjunctive with their smartphones, preventing them from share-out data with family members, physicians, and caregivers. After a thorough review articl of the law and our regulations, CMS is announcing that Medicare's published reportage policy for CGMs testament constitute modified to support the habituate of CGMs in coincidence with a smartphone, including the important data-sharing run they provide for patients and their families."

From what CMS Decision maker Seema Verma tweeted at the prison term of this announcement, we're eventide more affected by this policy revision:

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Woot!!

This decision came less than a week after a key advocacy meeting with CMS on June 6, in which various diabetes groups met with CMS officials to share patient stories and push the agency to make this change. Those orgs included the North American nation Association of Clinical Endocrinologists (AACE), American Association of Diabetes Educators (AADE), the Endocrine Society, and the Diabetes Patient Advocacy Coalition (DPAC).

According to Christel Aprigliano who leads DPAC, this policy change is a direct issue of the community's efforts: More 2,700 messages were sent to Congress and CMS via the DPAC web platform alone, let alone all the calls and letters and else social media calls to action from the D-Community.

Dexcom echoed that opinion in its official press release, with a quotation from Senior VP of Global Access, Claudia Billy Graham (WHO lives with T1D herself):

"We would also like to recognize the diabetes community for their efforts in voicing the necessity for this change. CMS listened and recognized the motivation to allow the sharing of glucose data in this population."

As to when this really takes set up, that's TBD.

The task of "rolling out" the newfound policy waterfall to the a group of Imperishable Greco-Roman deity Equipment Medicare Administrative Contractors, who need to issue a altered policy article. Advocates familiar with this issue believe information technology will likely happen in the orgasm weeks.

The Diabetes Community Responds

Crossways the D-Community, people are responding with joy to this news, knowing that information technology sets the stage for full coverage of related data-determined diabetes tools.

E.g., Laddie Lindahl from Gopher State, who entered the Medicare arena in upright the past few years and has been worried close to her inability to use CGM data-unselfish apps when that time comes.

"I am thrilled," she says. "Although I do not compel monitoring by a friend OR sept member at this time, I know that could change in a minute. I appreciate knowing that soon I will have access to Dexcom Postdate features and that those people who urgently and currently need BG monitoring will exist safer. I'm encouraged that Medicare beneficiaries with vision problems and opposite disabilities will be able to exercise the accessibility features of their smartphones to access their CGM information and alerts."

At present, Sonny hopes the Medicare ruling volition comprise interpreted to allow for her Tandem t:slim X2 insulin pump to personify victimised alternatively of her Dexcom CGM receiver as well.

"I am grateful for not being abandoned by Dexcom and for the advocacy of DPAC and the entire diabetes residential area," she adds.

Likewise fellow T1D peep Susan Mustian in KY is activated to discover about this pole-handled-awaited Medicare policy change. While she's not along Medicare at the import being 55 years sexagenarian (and T1D for 32 years), she has a neighbor and closely knit friend named Frank who's 67 years old and lives with type 2, and has intimate this issue firsthand.

"I've been talking to my supporter for a year about getting the Dexcom, and last week I helped him put in and start on that," she aforesaid. "He told Pine Tree State, and Dexcom habitual, that he could not use the iPhone features flat with his wife worried about not being allowed to espouse him. This is with child intelligence for my T2D friend. I know the Dexcom Share app used by my family has saved Maine from a life-threatening Low and like a sho I'm relieved IT can help him too!"

Like others in our D-Community, we're very too big for one's breeches to see this collective effort lead to subject policy change. Access is so enormously evidential, and it's good to know that Medicare is taking steps in the right commission to make a point all people with diabetes have get at to the most advanced tools.