More on Reimbursement

CMS relents, opens up smartphone-connected CGMs for reimbursement

CMS will reverse a longstanding unpopular position on reimbursement for smartphone-connected continuous glucose monitors.

The Centers for Medicare and Medicaid Services will reverse a longstanding unpopular position on reimbursement for smartphone-connected continuous glucose monitors, CMS announced yesterday.

"CMS heard from numerous stakeholders who shared their concerns that Medicare's CGM coverage policy limited their use of CGMs in conjunction with their smartphones, preventing them from sharing data with family members, physicians, and caregivers," the agency wrote. "After a thorough review of the law and our regulations, CMS is announcing that Medicare's published coverage policy for CGMs will be modified to support the use of CGMs in conjunction with a smartphone, including the important data sharing function they provide for patients and their families. The Durable Medical Equipment Medicare Administrative Contractors will issue a revised policy article in the near future, at which time the published change will be effective."

CMS opened the doors for reimbursement of CGMs in a January 2017 decisionBut in a footnote, the ruling excluded reimbursement for anyone who uses a smart device to access their CGM data, even if that device is used in addition to a dedicated receiver.

"Coverage of the CGM system supply allowance is limited to those therapeutic CGM systems where the beneficiary ONLY uses a receiver classified as [durable medical equipment (DME)] to display glucose data," CMS wrote at the time. "If a beneficiary uses a non-DME device (smart phone, tablet, etc.) as the display device, either separately or in combination with a receiver classified as DME, the supply allowance is non-covered by Medicare."

The decision prompted an outcry from the diabetes patient community and even led to a letter to CMS Administrator Seema Verma in March from senators Susan Collins (R-ME) and Jeanne Shaheen (D-NH) and representatives Tom Reed (R-NY) and Diana DeGette (D-CO).

Dexcom, whose G5 CGM was the first to meet CMS's reimbursement qualifications, applauded the decision in a press release.

"On behalf of our Medicare population, Dexcom would like to recognize and thank CMS for this policy coverage update," President and CEO Kevin Sayer said in a statement. "This update allows patients to access the full functionality of the Dexcom G5 CGM system as approved by the Food and Drug Administration (FDA). By doing what is right for the patient, CMS is creating value for the entire healthcare system."

"We would also like to recognize the diabetes community for their efforts in voicing the necessity for this change," Claudia Graham, Dexom's SVP of global access added. "CMS listened and recognized the need to allow the sharing of glucose data in this population."

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