Medicare will soon cover smartphone apps used with approved continuous glucose monitors (CGMs) for diabetics, according to a statement released by the Centers for Medicare and Medicaid Services (CMS).
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“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.”
The reversal of this longstanding rule follows a push from diabetes advocates, lawmakers and stakeholders, who demanded coverage of connected smartphone apps since CMS first announced CGM devices would be categorized as Durable Medical Equipment (DME) in January 2017. But the ruling excluded reimbursement for anyone who uses a smart device to access their CGM data, even if that device is used in combination with a dedicated receiver.
CMS at the time said that coverage of the CGM system is limited to those therapeutic CGM systems where the beneficiary uses the device to display glucose data. But if a non-DME device such as, a smartphone or tablet, is used as the display device, either in combination with or separately from the DME device, it would not be covered by Medicare.
Their decision triggered an outcry from the diabetes patients and their loved ones, and even prompted a letter written 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).
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Dexcom applauded the decision in a press release; The company’s G5 CGM was the first to meet CMS’s reimbursement qualifications.
Dexcom CEO Kevin Sayer thanked CMS for their policy change in a statement. Sayer said this update will allow patients to enjoy the full functionality of the FDA-approved Dexcom G5 CGM system. He also said that the decision shows that CMS is creating value for the healthcare system.
In a statement, American Association for Diabetes Educators (AADE) said the change will allow better monitoring of diabetes, especially for children and older adults, and it will also enable the health care providers to make better therapeutic decisions by using apps to interpret data from meals, exercise, insulin boluses and medications. The policy change will also allow people with diabetes to get expanded coverage, AADE said.
