Memorandum

Medicare CGM Access Act of 2014 introduced in the Senate – July 30, 2014

Executive Highlights

  • Today, US Senators Susan Collins (R-ME) and Jeanne Shaheen (D-NH) introduced the Medicare CGM Access Act of 2014 (S. 2689), which would establish Medicare coverage of CGM. The bill also paves the way for reimbursing artificial pancreas devices.

Today, Co-chairs of the Senate Diabetes Caucus, Susan Collins (R-ME) and Jeanne Shaheen (D-NH), introduced the Medicare CGM Access Act of 2014 (S. 2689). The bill is posted online here, and it would create a Medicare benefit category for CGM and establish a payment and coding structure to go along with it. This is a very important issue in our view as many more type 1 patients live to be 65 – and want to stay on CGM! It is shameful from our view that given all the evidence (though not specifically in over 65 folks, granted) on CGM, that Medicare does not currently cover it.  Notably, the bill has been drafted to pave the way for reimbursing future artificial pancreas technologies.

There is certainly a long way to go before this is anywhere near law, but the move is highly encouraging and sorely needed from a patient perspective. Medicare has always denied CGM coverage, thereby preventing many older patients from accessing this lifesaving technology unless they pay out of pocket – this is an enormous concern, as T1D Exchange data has reported that severe hypoglycemia is far more common in the elderly and significantly higher than previously appreciated. Medicare’s objection to covering CGM has centered on the technology’s adjunctive labeling (i.e., fingersticks are still needed), which in the payer’s view, means it is precautionary and not medically necessary. Of course, this ignores a wealth of clinical data supporting the technology’s benefits for reducing moderate and severe hypoglycemia (and in the future, alerting loved ones through remote monitoring of alarms). Medicare originally denied a 2012 benefit category request for CGM, and as we understand it, has refused to budge despite repeated attempts from major stakeholders in diabetes.

Notably, the legislation reflects true collaboration aimed at helping patients – the coalition that has worked on this issue includes JDRF, the Endocrine Society, AACE, AADE, Dexcom, Medtronic, and J&J. JDRF was out in full force on the news today, including a press release commending the bill and two advocacy asks: emailing US Senators to co-sponsor the bill and signing a petition to urge Medicare to cover CGM (the latter is at an impressive 3,845 signatures already out of a goal of 10,000, which will almost certainly be reached quickly). Both measures are phenomenally easy to take part in and took us less than three minutes total! JDRF is perhaps the best in the business when it comes to grassroots advocacy and reimbursement, and it’s truly outstanding for the diabetes community to see the organization’s focus on this issue.

From here, the bill would to pass through the Senate, and similar companion legislation would need to be introduced and passed in the House of Representatives. As we understand it, passage in the Senate this year is likely a long shot (November elections are a significant disruption), though it is still possible in the “lame duck” session of Congress before Winter recess. Our fingers are crossed!

  • According to T1D Exchange data, severe hypoglycemia occurs much more commonly in adults with longstanding type 1 diabetes. Within three adult age groups (31-50 years, 50-65 years, >65 years), 17-22% of those with a diabetes duration over 40 years experienced severe hypoglycemia in the past 12 months compared to 7-8% of those with a diabetes duration <20 years. The T1D Exchange uses a tight definition of severe hypoglycemia: seizure or loss of consciousness (one or more events) in the past 12 months. This data was first shared at the T1D Exchange 2013 Annual Meeting.

Close Concerns Questions

Q: What percentage of Medicare patients would be ideal candidates for CGM? (We assume all.)

Q: How will the bill pave the way for reimbursement of artificial pancreas technologies?

Q: Even if the law doesn’t pass, will political pressure from Congress and the JDRF petition push Medicare to reconsider its position?

Q: How long will it be until CGM obtains an insulin-dosing claim?

 

-- by Adam Brown and Kelly Close