February 01, 2023
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Pathak reported no relevant financial disclosures. Please see the study for relevant financial disclosures of all other authors.
Health insurance policy changes that expand access to continuous glucose monitoring for adults with type 1 or type 2 diabetes could greatly increase uptake of the devices, according to a study published in Diabetes Technology and Therapeutics.
In December 2018, BlueCross BlueShield of North Carolina changed policy to reduce prior authorization requirements for CGMs and provide the devices through the pharmacy benefit to nearly all members with type 1 or type 2 diabetes using insulin. In an analysis of claims data, the researchers found CGM uptake increased in the quarter immediately after the policy change took effect and continued to increase through December 2020.
“While CGM is now recommended as the standard of care for patients on insulin who can use it independently or with a caregiver, coverage of CGM systems varies among insurers,” Shweta Pathak, MPH, PhD, Written by senior healthcare researchers and colleagues at the Cecil G. Shepps Center for Healthcare Research at the University of North Carolina. “Coverage through the Pharmacy Benefit appears to expand access to these systems and coverage through the Medical Benefit has many advantages, including reduced costs of products through greater leverage in productive contracts, more specific and timely claims data, reduced administrative burden of manual pre-authorization, and a greater degree of procurement.” Increase member access through a convenient site.”
Use of CGM increases after policy change
The researchers collected administrative claims data from December 2016 through November 2020 from Blue Cross North Carolina. Data were analyzed on a quarterly basis, with the first quarter of policy change beginning December 1, 2018. Adults with at least one inpatient claim for a diabetes-related diagnosis or two outpatient claims or at least one outpatient claim with a diabetes diagnosis and a claim for a diabetes-related medication were included. All participants had at least one claim for insulin use during any 365-day period. CGM use was defined as any prescription or medical claim for a CGM receiver, transmitter, or sensor during a quarterly period.
Included in the study were 43,491 people with insulin-using diabetes, of whom 25.1% had type 1 diabetes and 74.9% had type 2 diabetes. At baseline, CGM was used by 18.8% of the type 1 diabetes group and 1.2% of the type 2 diabetes group. In the quarter before the policy change, from September to November 2018, 30.5% of those with type 1 diabetes and 2.6% of those with type 2 diabetes used CGM. In the next quarter after the new policy was implemented, CGM use rose to 40% in the type 1 diabetes group and 6.6% among those with type 2 diabetes. At the end of the study period, 58.2% of adults with type 1 diabetes and 14.9% with type 2 diabetes were using CGM.
CGM use increases across all insurance types
Among adults with type 1 diabetes, 57.3% of self-insured used CGM at the end of the study compared with 50.4% without policy changes. Among adults with type 1 diabetes and fully insured, CGM use was 61.8% versus 44.5% predicted without policy change, and CGM use was 57.2% versus 38.9% predicted use without marketplace or independent insurance.
For adults with type 2 diabetes, CGM use was seen in 17% of those with full insurance versus a predicted 4.1% without policy changes. Among adults with type 2 diabetes who were self-insured, 14% used CGM compared with 5.1% predicted without the policy change. Among adults with type 2 diabetes and independent or marketplace insurance, 15.5% used CGM versus 4.1% predicted without the policy change.
“As the utilization management criteria implemented with this policy change the limited use of CGM for patients with diabetes using insulin, the increase in CGM use reflects those benefiting from the use of CGM devices and alignment with clinical guidelines,” the researchers wrote. . “Further work is needed to assess the impact of this change in trends on medical expenditures to capture clinically relevant and patient-reported outcomes as well as the full impact of this policy change. Furthermore, work is needed to measure the impact of additional use on diabetes outcomes in a real-world setting.”