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Paying for CGMS Day
The online diabetes community, led by Gina Capone, has dubbed today a special day to lobby for insurance coverage of new continuous glucose monitoring systems. The idea is that we all raise our voices, by talking openly about how important CGMS is to our health, whether it’s simply for preventing lows at the gym or for dodging fatal heart attacks and strokes.
As most of you know, CGM systems are new to the market and still in early stages. I’ve been lucky enough myself to try out the first two commercially available, one from DexCom and one from Medtronic (the Guardian). I’m looking forward to testing the third system recently approved by the FDA, the Navigator from Abbott Diabetes.
Because these systems are still considerably difficult to use, need a lot of calibration and/or warm-up time, and are not nearly as accurate as fingerstick testing, there’s been a lot of hot debate about how hard we as the patient community should push for insurance reimbursement. The JDRF has a big campaign going, and the CEO of Diabetech has even set up an informational site called CGMS Central. Some significant progress has already been made, with Aetna and Wellpoint stepping up to the plate.
Manny from TuDiabetes recently created this video exploring the frustration of those who want and need CGM systems the most.
From my vantage point, I’m a little torn: My personal experience says CGM systems are not (yet) the panacea of diabetes care you might imagine. I’ve actually tried three systems if you count the early DexCom Three version, and learned the hard way that it was a good thing I hadn’t lobbied too hard for insurance coverage of a system I later chose not to use, for all the reasons mentioned above. I know there’s a limit to how many devices I can lobby my insurance for, so I want to pick my battles carefully.
Thus, I can see how insurance companies aren’t quite ready to plunge into ubiquitous coverage for CGM devices just yet.
On the other hand, two big points:
1) There are plenty of patients with hypoglycemic unawareness or severely fluctuating glucose levels who could really use this technology for a quality of life improvement NOW.
and
2) CGM is improving and on its way to becoming mainstream, so if we EVER want the insurance companies to cover it, we probably do need to start lobbying immediately. We don’t want to give them any reason to back off supporting the best tools available for diabetes care.
Assuming today’s goal is to catch the attention of people not already knee-deep in the CGMS campaign, I’m going to direct you all to find out more about CGM systems and how the JDRF views this as the critical bridge to an eventual Artificial Pancreas HERE.
And keep your eyes peeled for more information here at DiabetesMine; my review unit of the new Navigator is due to be delivered next week. I’m hoping this is going to be the one to solidify CGM’s place in the permanent D-care toolkit.
Explore posts in the same categories: CGM Adventures (Continuous Glucose Monitoring), Diabetes Blogs and Web Stuff
Hi Amy,
Love the post about CGM. Very interesting stuff!
Have you heard the latest from Animas? FDA Cleared OneTouch(R)Ping(TM) glucose management system. More info on the website http://www.animascorp.com/ViewAnnouncements.aspx?ID=85
Keep on blogging, we’ll keep reading!
All the best,
Posted by: Melissa Katz | July 1st, 2008 at 8:26 amMelissa
Great post Amy!!!
Thanks for the insight and POVs of someone who has been at the forefront of this technology.
My main point is simply this:
“It angers me that a company would tell someone that something is not medically necessary. They are not in the medical field and I highly doubt they have any health issue remotely close to being chronic. Who are they to say what someone needs?? Who are they to deem what is medically necessary for a person??
…
How about the person with the chronic illness, along with their doctor (medical team in some cases), make that decision? Where are Our choices?”
Guess it’s not so simple…
Posted by: CALpumper | July 1st, 2008 at 9:01 amAppreciate your honesty Amy! I’m one of those T1 D’s with the hypo unawareness and it’s created some pretty scary circumstances involving 911 calls and such…. I’m confident this technology is a new step in tighter control and over the next couple years it will be integrated into pumps and widely accepted….. but the sooner the better for us who suffer from hypo-unawareness!!
Have a great day!
Posted by: Windy | July 1st, 2008 at 11:13 amAmy,
My issue is as you have mentioned. The devices are not perfect for everyone and I’d hate to start seeing insurance rates increase for patients to get them and just waste money on an item that doesn’t work for them.
There’s also the fact that if they can be handed out like candy that some will get them that shouldn’t deserve them. In my opinion, if one is willing to fight a little to get a device, then they have the knowledge and patience to use it. Just think of what could happen if someone uses the device and doesn’t follow the directions to test before giving insulin? Say the device shows them at 200 and they correct. But in reality they are 120. This could create a car accident or other catastrophy.
The last issue I look at is when BG meters came out it took over 15 years for those to be widely accepted. When pumps came out I’d say around 10 years to be widely accepted. Now, we have CGM and people want it now. Is this just marketing push of the companies? Push of doctor’s offices? Why all the sudden a rapid change in want for a medical device? Let’s give the device time to be proven useful and reliable so insurance companies can see a need for one.
Posted by: Kevin D | July 1st, 2008 at 1:36 pmAmy,
I am wearing CGMS, and because I live ALONE and have a major (rational) phobia about nocturnal awareness, I really benefit from these sensors. They allow me to fall asleep at night. I’ve had diabetes for 36 years this month, and for most of them (excepting the first 10 years, when I had TOTAL hypoglycemia awareness, I have set my alarm for the middle of the night, or drank a glass of water (so I’d have to wake up to use the bathroom) or taken too big a snack at bedtime, out of a great fear of nocturnal hypoglycemia.
I also suffer from daytime hypoglycemia awareness. When I was first diagnosed my hands used to shake when my BG hit 75; now they don’t shake at all. I usually just start crying when my BG’s get to 60. CGMS works for me!!!!
June
Posted by: June S. | July 1st, 2008 at 7:39 pmI just have serious problems with the insurance companies telling me what is best for me. When my doctor, CDE, and I all can agree that I would be a good candidate for a CGMS, that should be enough for the insurance company; regardless if I use it 24×7 or just a few times per month. The insurance companies are paid by people like me and the companies we work for. It would be nice if these same insurance companies would work for their customers, IE people like me.
I *am* willing to pay out of pocket, but I don’t want to set a precedent and ruin it for everyone else. I WILL fight (and am fighting) to get BCBS to cover a CGMS for me and the rest of you.
Posted by: Jef | July 1st, 2008 at 10:34 pmCan we now have a day to raise awareness of the ridiculously high price of test strips?
Posted by: Patty | July 2nd, 2008 at 5:50 pmI have to say I agree with Kevin D. I fought with our insurance company to approve the CGMS for our 20-yr old son. After a few months, we finally got it approved. He went on the CGM a few weeks (3 sensors ago) and he is already fed up with it and is taking a break. At this point for me, I would say the CGM is valuable for parents with young T1 kids that just do what their parents says and for adult diabetics that have a routine and are willing to take the time to work with the monitor and data. I would say older teens and young adults are not good canidates for the CGM. As I have discovered, it takes a lot of work and attention to get value out of a CGM. It can be frustrating for a young adult.
Posted by: Al | July 3rd, 2008 at 9:01 amAll of you have valid points. I do think that people that really want a CGMS are the ones that are willing to work. Such as people like me. I also understand that this isnt top notch yet. But niether was any other device when it first came out. Blood machines, pumps and now CGMS.
Kevin Stated: “Why all the sudden a rapid change in want for a medical device? Let’s give the device time to be proven useful and reliable so insurance companies can see a need for one.”
The data that this provides is helping so many people. It is giving people the chance to sleep, drive a car and sit in a classroom, without worry of low blood sugars. It may not be perfect but it has been proven to work. I have been wearing a pump for the last 7 years and it still gives me problems time to time, no piece of machinery is perfect. There is always room for improvement.
I have been struggling with high/low blood sugars for the past 6 years and I need this data. I need my levels to be in normal range. I want to be a mother one day and my levels just are too high from low blood sugar rebounds. If this is going to help me get in better control I will fight. Its not for everyone just the way the pump isnt for everyone. We all have our opinions.
Posted by: Gina | July 3rd, 2008 at 9:42 pmIt’s immoral that insurance companies can deny this sort of thing. The whole problem is that they are for-profit, so it’s always in their interest to NOT pay for treatments. I am constantly amazed that there isn’t more outrage about the stranglehold that the insurance industry has on health care. If a doctor says it’s necessary, it should be illegal for the insurance company to deny it — otherwise, what’s the point of insurance? Why do we have to muddle through with clunky old technology while insurance companies drag their feet, delay payment, and deny coverage? People’s lives are more important than corporations’ billion-dollar bottom lines.
As for me, I am still trying to get the basics covered (like insulin). Pumps, CGMS, etc would be asking for the moon.
Posted by: LaurenK | July 6th, 2008 at 9:33 pm