Introduction and Objective: The Alliance of Community Health Plans (ACHP) is a nonprofit trade association representing nonprofit community health plans. To advance its Chronic Disease Pledge to improve diabetes outcomes by 2030, ACHP members worked together with the International Diabetes Center to understand payer policies related to continuous glucose monitoring (CGM). This project, supported by a grant from the Leona M. and Harry B. Helmsley Charitable Trust assessed nonprofit community health plan coverage and its impact on CGM access and utilization.Methods: We used a mixed-methods design combining a literature review, survey and analysis of utilization data from 2023. Twenty-one ACHP member plans received a line of business-stratified survey to assess CGM coverage policies such as incentives and barriers. Plans completed a data collection tool to quantify real-world CGM uptake, disparities in CGM use and outcomes. Survey findings and utilization data reports were analyzed descriptively.Results: Fifteen plans responded to the survey and eight submitted utilization data. All plans covered CGM for people with insulin-requiring diabetes under commercial and Medicare coverage. Two Medicare and three commercial plans required cost sharing. CGM coverage decisions were driven by evidence of improving overall patient outcomes (87%), CGM improving glucose management (80%), and cost-effectiveness (67%). Of those who responded, no plans offered provider incentives to prescribe CGM; one plan offered patient incentives. Among commercially insured members, 61% of people with type 1 diabetes (T1D) used CGM, 46% on Medicaid, and 47% on Medicare. Higher percentages of CGM users with T1D had an HbA1c less than eight across lines of business (56% vs. 46% Medicare, 37% vs. 24% Medicaid, 47% vs. 33% commercial).Conclusion: ACHP plans CGM coverage policies align with the 2024 ADA recommendations for coverage, but opportunities exist for plans to improve CGM uptake.
C. Raley: None. G. Carmichael: None. M. Severson: None. G. Simonson: Other – My employer International Diabetes Center HealthPartners Institute has received education grant; Current; Abbott Diabetes. Consultant; Current; Dexcom, Inc. Other – My employer International Diabetes Center HealthPartners Institute has received education grant; Current; Medscape. R.M. Bergenstal: Other – Advisory Panel, Consultant, Clinical Research Support; Current; Abbott Diabetes. Other – Consultant, Clinical Research Support; Current; Dexcom, Inc. Research Support; Current; Amgen Inc. Advisory Panel; Current; CeQur SA. Other – Advisory Panel, Consultant, Clinical Research Support; Current; Eli Lilly and Company. Research Support; Current; Insulet Corporation. Research Support; Ended; Luna. Research Support; Current; Medtronic. Other – Advisory Panel, Consultant, Clinical Research Support; Current; Novo Nordisk. Research Support; Current; Tandem Diabetes Care, Inc. Consultant; Current; Sanofi. Advisory Panel; Current; Vertex Pharmaceuticals Incorporated. Research Support; Current; Zealand Pharma A/S, Sequel, Embecta. J. Lee: None.
The Henry B. and Leona M. Helmsley Charitable Trust
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