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16 Responses

  1. Elder Care Bradenton
    Elder Care Bradenton March 24, 2014 at 4:33 am | | Reply

    I’m amazed at how the needs of diabetics are ignored by Medicare despite the $245 Billion price tag. With Medicare being run by the government it makes me even more nervous about the Affordable Care Act allowing the Government to take over the healthcare industry in our country. I’m not confident that they will be able to run it efficiently or effectively.

  2. Kim
    Kim March 24, 2014 at 6:15 am | | Reply

    Thank you for highlighting this, Mike.

  3. June S.
    June S. March 24, 2014 at 7:47 am | | Reply

    I so agree with Elder Care Bradenton (above.) The problem is this, in a nutshell … Since ObamaCare is set to provide benefits for people who never had them before, and that costs money, and since Medicare dictates what ObamaCare and private insurers can and cannot cover, AND since CGM is expensive, and since people have lived without it for decades, its importance is being ignored. I have used a CGM system for the past 6 years, and cannot think of going without it (as I did for the 35 hellish years prior to using CGM!)

  4. StephenS
    StephenS March 24, 2014 at 8:40 am | | Reply

    Mike, thanks for reviewing this important topic. My take: CGMs are definitely medically necessary for patients on Medicare. Now we just have to get our legislators to say “Yes, we agree with you”.

  5. Anna McCollister-Slipp
    Anna McCollister-Slipp March 24, 2014 at 8:44 am | | Reply

    Fantastic piece, Mike!!! Thank you for highlighting this issue and raising awareness of the things that are happening on this front. The most important thing we can do to change the CMS equation long term is to push for better outcomes measures, such as Bergenstal’s proposed AGP or proposals for “time in range”. As long as A1C is the “be all, end all” measure for evaluating diabetes drugs and devices, this issue will remain.

    The National Quality Forum has recently begun reviewing quality outcomes measures for endocrine diseases, which will be used by CMS to determine which doctors/hospitals/health plans are providing good quality care and therefore are eligible for incentive payments under the ACA and HITECH Act. They are accepting measure submissions now, which will be evaluated by the newly appointed endocrine standing committee. I was appointed to the committee in December, so if anybody is interested in learning more, please let me know.

    Again, excellent, excellent piece! Kudos!

  6. David
    David March 24, 2014 at 8:57 am | | Reply

    I suspect Medicare needs to see that CGM can drop the overall cost of healthcare for PWD’s by reducing bg deviations and preventing complications and this would require a long-term landmark study. Certainly, seeing bg patterns in real-time “video” is eye-opening and can potentially motivate PWD’s to significant improvements in bg management. But this obscures the real value of CGM which is to improve quality of life. Non-PWD’s can’t understand what it is like to live with the 24/7 threat of unpredictable bg. I feel better and I am more confident to be active and go about my life. The drop in my A1C is modest but the peace of mind is invaluable. Sometimes I feel a flash of what I felt like before dx, emotionally and psychologically more secure (there’s good reason why PWD’s suffer depression!) . I hope someday the technology can improve enough to drop the cost and be accessible to more of us.

  7. Marge Stromberg
    Marge Stromberg March 24, 2014 at 9:06 am | | Reply

    A CGM would certainly be an asset to me. I’m not willing to pay the price (yet) that a friend did to have it. I continue to be amazed however that as long as I have an insulin pump, Medicare covers my strips (6-8 a day) and supplies. I have to jump through seeral hoops to have it. But that’s okay for now. I note that coverahe for people with type 2 or without a pump have more restrictive services for strips.

  8. David Kliff
    David Kliff March 24, 2014 at 11:18 am | | Reply

    I read with interest this post today on CGM/Medicare reimbursement and of course I have been following the fallout from competitive bidding – while I think it’s great that the diabetes blogging community is finally becoming active on this issue however this may just be a case of too little too late – honestly it’s highly unlikely that Medicare would go backwards as they have already booked the savings into future budgets – and your readers should be prepared as it’s going to get much worse – the day is fast approaching when private payers will no longer reimburse for test strips unless the patient is on insulin therapy and even then they are likely to raise co-payments to transfer more the cost to the patient – this trend has been going on for years and will continue – the fact is the diabetes community was let down by the ADA, JDRF, Industry and yes the blogging community – the fact is our elected officials have no clue what a patient goes through each and every day – that patients with diabetes even with our vast numbers don’t have an effective voice in Washington – just wait until the FDA wants meters to be more accurate (something many are pushing for) – do you really think BGM companies will stay in the business – I’m not against more accuracy but the added cost of making meters more accurate is never discussed – think of how you would feel if the rates you charge for ads was cut by 72% and then the government told you to add more security to the site.

    If the blogging community really wants to make a difference you should expose the organizations (ADA, JDRF) that failed their mission – aren’t they supposed to look out for the interest of patients – is this not why we pay dues and make financial contributions – yes things like the artificial pancreases are nice and all but even if this device was ready today it would only impact a handful of patients – yet competitive bidding, the lack of NIH funding, the policies made in Washington impact MILLIONS of patients TODAY –

    As you know due to my personal situation I also take an active role in the cancer world – I can tell you that there is no way the American Cancer Society or many of the other cancer related organizations would have let something like this happened without putting up a fight – unlike the ADA and JDRF who stood by doing nothing – these organizations would have been proactive – this doesn’t mean they would have been successful but at least they fought – the way I see it the ADA and JDRF let everyone down as they didn’t bother to fight – just my humble opinion.

    David Kliff,
    Publisher
    Diabetic Investor

  9. Richard Price
    Richard Price March 24, 2014 at 11:29 am | | Reply

    The CGM is said to be costly however in real life it goes a long way in helping to prevent the many side effects of diabetes . Living with diabetes is like flying blind not knowing where you are resulting in many crashes. For flying they designed the altimeter which indicates how high or low the plane is above sea level. The CGM does the same thing, telling how high or low a persons blood sugar is, thus preventing hypoglycemic crashes. The cost of Diabetic care would be reduced drastically plus it would make it possible for diabetics to have the best careavailable enabling diabetics to live a normal li
    A having been insulin dependent for more than 53 years myself, it pains me to see younger diabetics being treated almost as poorly as I was when I first was
    discovered to be a Diabetic.

  10. Sue Berger
    Sue Berger March 24, 2014 at 2:53 pm | | Reply

    I can’t thank you enough for your post today. I have been fighting for this for over a year and at this point, need all the exposure that I can get to get the message across. We are forging ahead with Level 4 of the appeals process and are hoping that we get good results. It’s been a long process and at times a very time consuming and daunting but with the DOC’s support and the exposure that we’re getting, we’re hoping that by the time us boomers are long gone, that our next generations will not be burdened with this fight. So I ask everyone, whether a diabetic, spouse, offspring or just a good friend, to please write their Congressperson and ask them to support H.R. 3710, sign petitions and just do whatever you can to Join in the Crusade. It’s important.

  11. Sue from New York
    Sue from New York March 24, 2014 at 3:52 pm | | Reply

    Excellent blog Mike, thank you for all the work you put into this most important issue.

  12. Jerry Smith
    Jerry Smith March 25, 2014 at 1:27 pm | | Reply

    I have been battling with my Medicare Advantage plan for CGM coverage since 2009. I lost my appeal which went through Level 4, Medicare Appeals Council, in Washington, DC. Medical necessity was never taken into consideration.

    The good news is that I have found another Medicare HMO in Rochester, NY, that will cover CGM as an extra benefit with prior authorization and a letter of medical necessity. I currently am using the MM 530G Enlite system. My copay for a box of five sensors is approximately $65 per month.

    The current Medicare CGM regulations, which are based on policy articles by administrative contractors were written almost ten years ago. One such LCD is NHIC Policy Article A33614 which has become Medicare policy. None of the organizations such as JDRF, ADA, AACE, etc. will support HR3710 or CMS.

  13. Bennet
    Bennet March 28, 2014 at 12:33 pm | | Reply

    One of my all time favorite B movies is the Gumball Rally a 1976 film about a cross country race. One of the classic line is a ringer F1 drive breaking off the rearview mirror and saying, “What is behind me does not matter.”

    So to David point about being let down, maybe, but I can’t chafe the past and if I don’t learn form it I am destine to relive it.

    The Gumball Rally was a long race, so is advocacy. I choose to be engaged not a spectator.

  14. Scott K. Johnson
    Scott K. Johnson March 30, 2014 at 11:05 pm | | Reply

    Thanks for spreading the word, Mike!

  15. Carol Juul
    Carol Juul April 20, 2014 at 8:14 pm | | Reply

    I too have Medicare and private insurance. Since Medicare won’t cover a CGM well what more do I need to say. I was fine without Medicare but was forced on it because of a disability. I don’t know how many times the ambulance was called but I guess Medicare think paying for that is better than paying for my sensors. Now I buy them out of pocket when they are cheap some of them outdated a couple of years, but medicaire doesn’t leave a choice. I better not go on anymore as I am so mad just thinking about it.

    Carol

  16. JoAnn
    JoAnn April 27, 2014 at 2:15 pm | | Reply

    While I had heard of and signed petitions supporting H.R. 3710 (Medicare CGM Coverage Act) introduced by Rep. Carol Shea-Porter, it was not until today that I realized this bill states that it “shall apply to the implementation of monitoring systems occurring on or after January 1, 2015.” Unless I’m reading this wrong, those of us who currently use a CGM would be excluded from coverage. This is very disturbing. I have had T1D for 58 years, diagnosed at age 7, and have frequent occurrences of hypoglycemic unawareness. Since Medicare covers insulin pumps and supplies for PWD who were using them before going on Medicare, the same should be true for CGMs.

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