Medicare and Diabetes Technology Coverage: Closing the Gaps

Medicare is the single biggest health care insurer in the United States. When Medicare covers products or services, millions of Americans benefit. 

Unfortunately, because Medicare is so big, the coverage policies are so complex, and medical technology evolves so fast, coverage often lags behind what’s available on the market. The gaps mean Medicare beneficiaries often have to wait for access to technology that would improve their health. Private insurers tend to follow Medicare’s lead, so the lag times ripple throughout the health care system. 

Diabetes technology is among what’s caught in the gap. This is a major challenge.

As many as one-third of the 66 million Medicare beneficiaries have diabetes.

Medicare enrollment and diabetes diagnoses are projected to grow as the Baby Boom generation ages into Medicare. Baby Boomers will live longer than the previous generation, smoking much less, for example, but with higher diabetes rates. 

Medicare tries to keep up with technology and demands but accomplishes only so much.  

For example, although continuous glucose monitors entered the marketplace in the mid-2000s and patients used them extensively, Medicare didn’t cover the devices until 2017, despite strong evidence supporting coverage. Even now, the coverage policy doesn’t fully address the way patients use the technology on their smart phones. 

Another example is the automated insulin delivery system. 

The FDA approved this technology and defined it as having three components: a continuous glucose monitor, an insulin pump, and a digital algorithm. The algorithm allows the monitor and insulin pump to talk to each other and automatically adjust the patient’s glucose levels. Medicare now covers and pays for each of the first two components as durable medical equipment, but regulations don’t say how the algorithm could be covered and paid for separately.  

Medicare should cover the algorithm as a supply necessary for the functioning of the technologies that do qualify for coverage, the same way Medicare covers test strips used with blood glucose monitors and oxygen used in canisters.  

The medtech industry is working with federal agencies and Congress to close these gaps. There’s a lot of work to do. The Centers for Medicare and Medicaid Services’ Transitional Coverage for Emerging Technologies (TCET) notice is a step in this direction, but it should be much stronger to ensure a predictable pathway to national Medicare coverage for new medical devices and diagnostics, including diabetes technology. 

Patients tell us all the time how the latest technology to monitor and manage diabetes is life-changing for them. I see that myself as the father of a daughter with Type 1 diabetes. As we recognize National Diabetes Month, I urge faster coverage of diabetes medtech for the millions of Medicare beneficiaries who deserve their best quality of life today, not tomorrow.  

For more, please see these resources:

• AdvaMed’s formal comments on the Centers for Medicare and Medicaid Services (CMS) Transitional Coverage for Emerging Technologies Notice 

• AdvaMed Center for Digital Health/CapView Strategies report, “Modernizing Medicare Coverage of Digital Health Technologies”