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Insurance Creates Red Tape Between Patients and CGMs

We’ve recently reported on Americans’ struggle to pay for exorbitant insulin costs. But it’s not just insulin. Other vital diabetic supplies for continuous glucose monitoring are also difficult for many patients to access. 

Life-changing devices like continuous glucose monitors (CGMs) are making diabetes management easier for many. But to get one, there are a lot of hoops to jump through. 

What are CGMs?

A continuous glucose monitor replaces finger pricks as a way to constantly monitor blood sugar levels throughout the day and night. The device attaches to your body and takes regular blood glucose readings via a wire inserted under the skin. It then sends that information to a smartphone or receiver so that the data can be stored and tracked. 

Readings are done every 5 minutes, for up to 288 readings per day. The CGM will sound an alarm if blood sugar drops too low, or if it senses a high forthcoming. Some even sync with an iPhone so you can ask Siri what your blood sugar levels are while you are driving. 

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Benefits of CGMs

Continuous glucose monitors have made a world of difference for people with diabetes. Using a CGM helps to lower A1C levels and reduce severe episodes of hypoglycemia, plus mitigates long-term effects such a kidney failure and nerve damage. 

Medical companies that offer CGMs include Dexcom, Medtronic, Abbott, and Senseonics. 

Insurance restrictions 

For each part of the CGM (the sensor, the transmitter, and the receiver), a patient has to get prior authorization via their doctor from their insurance company. In addition, in some cases each time a patient needs new sensors, the patient has to go through the process all over again.

The hoops people have to jump through can lead to patients stopping treatment or even experiencing dangerous life-threatening health situations.

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Effects on doctors

The prior authorization process weighs on doctors as well. Doctors and endocrinologists are in agreement, calling for an end to the prior authorization red tape, especially for diabetes devices. The American Medical Association even created a website to help fix the issues that prior authorization creates, causing patients to experience delays or be denied supplies.