That above total is $4770. Take into account say a 20 year old with type 1 going to 60 years old. That is $190,800 in coverage there. There are very few complications that even get near that cost in diagnosis and treatment.

That is the problem with insurance companies right now. They have to factor in which costs less. Remember, they already lose money on diabetics with insurance supplies, so a CGMS is just another item to costs more money.

While I think it would be great if they covered CGMS, they have to look at where the benefit to them is, not to mention, they rarely cover first generation devices. Insulin pumps weren’t covered for about 10-15 years after they initially came out. Same applied to home BG meters.

- trust that I’m trying and give me positive reinforcement to try harder
- look at trends, rather than alarmedly pointing out the random 350 that, who the hell knew sushi had so many carbs in it? I corrected. It’s over. Yes, I know high blood sugars are Bad.
- return my phone calls promptly and not delegate to a nurse who then has to go and ask the doctor and call me back AGAIN
- I know this is probably pie in the sky, but my ideal endo model would be a scheduled ten minute phone consultation every two or three weeks to review uploaded data. Far more useful than an every three month checkup that lasts half an hour. Pluses: I get to stay on schedule. The doctor gets to stay on schedule. We’re not looking at ancient history.

I remember seeing the first comments via David Kliff about how poorly this meeting went and felt that it was a real blow to the prospects for CGM reimbursement in the near term. However, on second thought, it would seem that a Medicare advisory committe is hardly the target audience for companies attempting to get insurance reimbursement primarily for Type 1 CGM. It just happened to be one of the first publicized opportunities for the companies involved to hone their presentation on the advantages to patient care and the resultant cost benefits to insurers. Before you completely dispair, give these companies some time and see if they get a chance to meet with and convert the real movers and shakers in Type 1 diabetes care reimbrsement over the next six to twelve months.

In twenty years from now, people will look back and think how barbaric life must have been without CGMS, just as we look back twenty years ago on SMBG policies. We just have to keep the pressure on as new technology comes to us… can you imagine testing your glucose 6 or 10 times a day with the Ames Reflectance Meter?!

http://www.cms.hhs.gov/faca/downloads/id36a.pdf

For example:
Question 2. Although the largest segments of the Medicare population are >65 and/or have type 2 diabetes, CMS is interested in the evidence base for newer technologies for glucose monitoring, including continuous monitoring of interstitial fluid and their role in type 1 diabetes. How confident are you that the effectiveness of continuous monitoring in patients with Type 1 diabetes is best assessed by changes in HbA1c, concomitant hypoglycemia rates, hypoglycemia-related falls, post-operative morbidity, wound-healing, and weight?

They also added quality of life to the final version. Unfortunately, some of the panelists were confident that weight and quality of life were good assessments of the effectiveness of continuous monitoring. YIKES. This will definitely be an uphill battle.

Oh, and I’m officially tired of waiting for Navigator and contacted the Dexcom rep this week. My order is in!

“I think that with a meter that reports results every five minutes, most users will quickly learn to make appropriate adjustments simply through experience and guesstimation. Software might be nice for historical analysis, but for most people, just knowing what’s going on RIGHT NOW will be of primary importance.”

I think this is what appeals to me – the potential of empowering the person with diabetes to make adjustments that apply to the exact situation that’s occurring.

How many times have you looked at historical data and tried to remember what exactly was different about that day, week, meal, activity, etc that might have ’caused’ a blood sugar? Historical data is interesting and certainly useful in spotting large trends, but I think people with diabetes can and will benefit from being able to see the road in front of them as they are driving.