Medicare to expand CGM coverage to more Type 2 diabetes patients

Medicare will cover continuous glucose monitors (CGMs) for a broader group of patients, starting in April, according to an updated policy published by the Centers for Medicare and Medicaid Services.

“The policy change comes earlier than expected and, according to one analyst, could double the market for the devices.

CMS had previously suggested covering the devices for people with diabetes who take daily insulin or who have a history of problematic hypoglycemia. Now, the policy includes people with non-insulin treated diabetes and a history of recurrent level 2 or at least one level 3 hypoglycemic event, so could open up a bigger opportunity for broader coverage by commercial insurers over the next year or two.

Currently, just 25% of people with Type 2 diabetes who are intensive insulin users (taking multiple shots per day) use a CGM. Covering people who take basal (daily) insulin could double the US market opportunity of about 2m people with Type 1 diabetes and 2m people with Type 2 diabetes who are intensive insulin users.

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