Support Medicare Coverage of Continuous Glucose Monitors (CGM)

Ask Congress to co-sponsor legislation to ensure people over 65 have access to life-saving CGM today.

Thousands of people are benefiting daily from tighter glucose control reached with the help of a continuous glucose monitor (CGM). However, Medicare does not currently cover CGM devices, leaving seniors with type 1 diabetes (T1D) vulnerable. It’s time for Medicare to cover CGMs.

Representatives Tom Reed (R-NY), Diana DeGette (D-CO) and Ed Whitfield (R-KY), leadership of the Congressional Diabetes Caucus, have introduced legislation in the U.S. House – H.R. 5644, the ‘Medicare CGM Access Act of 2014′ – that would facilitate Medicare coverage of CGMs, and help pave the way for the next generation of CGM-related technologies, such as artificial pancreas (AP) systems. This legislation now joins its bipartisan companion bill (S. 2689) introduced in the Senate by Senators Susan Collins (R-ME) and Jeanne Shaheen (D-NH), Co-chairs of the Senate Diabetes Caucus.

We need your help today to help us advance this important priority! Please take a minute to 1) email your Representative and ask that they co-sponsor this important legislation, H.R. 5644; then 2) e-mail your Senators and ask that they co-sponsor S. 2689. You can also 3) sign our petition to Medicare, and help ensure those with Medicare have access to life-saving CGM technologies. After you take these actions, please share this message, asking your friends and family to do the same.

CGM_seniors_Jun 2014

The CGM has been shown to improve glucose control – preventing dangerous high and low blood sugars. The use of CGM technologies is recommended by national diabetes clinical guidelines and covered by nearly all private health plans. To date, Medicare does not cover CGMs, regardless of the wide coverage by private health plans and the evidence of clinical benefit.

JDRF has been working closely with other interested stakeholders for more than a year to encourage Medicare to cover CGM devices, and we have made Medicare coverage of CGM devices one of our top Advocacy priorities. While JDRF continues to work with Medicare in hopes of resolving this issue quickly, we ask that you join us in building support within Congress for Medicare coverage of CGMs. To learn more, read our coalition fact sheet.

Research Shows – The CGM is Beneficial

People with T1D have to test their blood glucose and give themselves insulin injections or infusions via a pump 24 hours a day, every day, in order to stay alive. Too much insulin can result in seizures, comas, or death from hypoglycemia (low blood sugar). Too little insulin can lead to devastating kidney, heart, nerve, and eye damage from hyperglycemia (high blood sugar).

The CGM is an FDA-approved, physician-prescribed device that detects and displays blood glucose levels continuously, and also reveals trends in a patient’s glucose levels that often go unnoticed by using finger-stick measurements alone.

CGM graph_Jun 2014

By viewing continuous data, and by responding to alerts from a CGM, patients can react to rising or falling glucose levels before they become dangerous. Trends over time can also provide insight into underlying causes of high and low blood glucose levels, enabling therapy adjustments to further improve outcomes. A JDRF-funded clinical trial, whose results were published in the New England Journal of Medicine and Diabetes Care, found that adults using a CGM had improved glucose control (or reduced A1c) and reduced rates of severe hypoglycemia. Many studies since the original trial have shown similar results. Based on this evidence, diabetes clinical guidelines by all leading diabetes professional societies recommend use of a CGM.

Decreasing Hypoglycemia in Seniors

Hypoglycemia, or low blood sugar, is the most frequent complication experienced by older adults with diabetes – 16 percent of elderly patients with long standing T1D have experienced at least one seizure or episode of unconsciousness in the past year due to severe hypoglycemia. Hypoglycemia is dangerous enough; however, the elderly’s high risk of hypoglycemia also increases their risks for falls, fractures, and related complications.

Patients over the age of 80 were 2.5 times as likely to visit the ER for an insulin-related hypoglycemia event, and nearly five times as likely to be admitted, versus patients between the ages of 45 and 64. By reducing hospital admissions for hypoglycemia, the CGM has the potential to improve quality of care while reducing unnecessary expenditures and the disproportionately high hospitalization rate.

The CGM – By the Numbers

  • A JDRF-funded CGM trial has shown that the rate of severe hypoglycemic events among adults using a CGM fell by two-thirds over the first year of use.
  • Currently, costs for a hypoglycemia inpatient admission average $17,564 per visit.
  • Diabetes is one of the costliest chronic diseases, accounting for $245 billion in economic costs in 2012, including $176 billion in direct medical costs and $69 billion in reduced productivity. Of the $176 billion in diabetes-related medical costs, 59 percent or $104 billion is attributed to those age 65 and older.
  • Overall, 42 percent of Medicare fee-for-service spending is attributed to people with diabetes.

What Can I Do?

As we mentioned above, right now there are THREE WAYS YOU CAN HELP US advance this important priority: Sign our petition to Medicare, and help ensure those with Medicare have access to life-saving CGM technologies; and lastly, tell the House and tell the Senate that they can change this policy – it is time for Medicare to cover CGMs. In addition, please sign-up to be a JDRF Advocate today, and help JDRF Advocacy urge Congress to pass legislation ensuring CGMs are covered by Medicare! You can also follow the conversation on Facebook and Twitter by searching #MedicareCoverCGM. If you would like others to learn more about CGMs and join us in our efforts, please share this page with your friends, family, neighbors and coworkers. For further updates, please check back with us often at this page.

Thank you for all that you do for your loved ones, and for JDRF Advocacy.

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