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Each year millions of Americans welcome reaching the age of Medicare eligibility, so their health insurance is no longer tied to their job or a partner’s. However, for people with diabetes, the transition from employer-provided coverage can lead to significant disruptions in care. Diabetes innovation is advancing at a remarkable pace. There are more blood glucose management medications, devices, and technologies than ever before. Medicare coverage determinations often become the accepted standard for commercial insurers and state Medicaid programs. But diabetes standards of care and individual patient needs change so rapidly that Medicare innovation adoption often lags commercial insurers.
In 2023, with encouragement from the Congressional Diabetes Caucus Co-Chairs and advocacy from patients, providers, suppliers, and other stakeholders, the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) finalized Local Coverage Determination (LCD) L33822. This LCD reflects clear, objective coverage criteria for continuous glucose monitors (CGM) based on clinical evidence and national practice guidelines. As DLC Board Chair Stewart Perry said, “Today marks a significant step toward Medicare coverage that truly reflects evolving diabetes technologies and standards of care. By improving coverage criteria for CGM, the Administration is paving the way for more affordable and equitable access to life-changing and lifesaving, but under-utilized diabetes technology.”
However, Medicare has yet to adopt evidence-based coverage of insulin pumps. Current insulin pump coverage criteria are detrimental to the quality and continuity of patient care, administratively burdensome to providers, and confusing for suppliers. The multi-stakeholder Diabetes Technology Access Coalition, of which DLC is a member, submitted a reconsideration request for National Coverage Determination 280.14, but to date, Medicare has given no indication of prioritization or timeline.
Mounting clinical evidence supports expanded use of CGM, insulin pumps, and automated insulin delivery (AID) systems to improve health outcomes for people with diabetes. These tools have become a standard of care, represented in national clinical guidelines from The Endocrine Society, American Association of Clinical Endocrinologists, and American Diabetes Association. The Association of Diabetes Care and Education Specialists hosts a virtual platform to help its members keep pace with the ever-expanding set of diabetes management technologies, including CGM, pumps, AID systems, as well as health apps and digital therapeutics.
Medicare beneficiaries cannot continue to be excluded from these standards of care based on outdated coverage criteria. Under the status quo, diabetes technologies will continue to be under-utilized by Medicare beneficiaries, with access skewed toward non-Hispanic whites rather people of color and people in lower-income communities, which bear a higher diabetes burden.
About the Diabetes Leadership Council: DLC is a 501(c)(3) patient advocacy organization committedto reducing barriers to effective, accessible, and equitable care by informing policymakers about thepriorities and lived experiences of the diabetes community. Our members – all former leaders of nationaldiabetes organizations – share a singular focus on patient-centered policy advocacy to improve the lives ofall people impacted by diabetes.
Erin Callahan, Chief Operating Officer, ecallahan@diabetespac.org
April Gutmann, Sr. Manager Government Affairs & Policy, agutmann@diabetespac.org
