Insurance & Coverage
Navigate insurance coverage, Medicare criteria, and reimbursement for CGMs.
6 Topics in this Category
Insurance Coverage and Medicare Criteria
CGM insurance coverage has expanded significantly following the CMS 2023 update, with Medicare, commercial insurance, and Medicaid all providing various coverage options.
Pharmacy Benefit vs. DME Benefit Economics
CGM access economics are split between Durable Medical Equipment (DME) and Pharmacy Benefits, each with distinct cost structures and access paradigms.
Cost-Effectiveness Analysis of CGM
Understanding the long-term cost-effectiveness of CGM technology compared to traditional glucose monitoring methods.
The Role of PBM Rebates in CGM Pricing
Pharmacy Benefit Managers negotiate rebates with CGM manufacturers that significantly impact device pricing and patient access.
Medicare Coverage Criteria Evolution
Medicare CGM coverage has evolved significantly, expanding access from intensive insulin users to broader diabetic populations.
Economic Impact of Non-Adherence
Non-adherence to CGM use costs the healthcare system billions annually through increased complications and emergency care.
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