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Equitable Care for Diverse Individuals and Populations

(D36) Variable CGM Coverage Policies Leave Privately Insured Patients Guessing About What's Covered

Sunday, August 9, 2026
4:40 PM - 5:25 PM ET
CE: .75 CE
Georgetown University’s analysis of private insurance policies shows that CGM coverage, utilization management policies, and medical criteria vary. This variation can be confusing for patients and prescribers and often means that DCESs must help patients to understand their coverage and how to access the CGM that they need. This session will discuss the variation in CGM coverage across private insurance plans and how plan policies that do not reflect the American Diabetes Association (ADA) Standard of Care impact patient access. The session will also include a discussion of how DCESs can support patients to navigate coverage challenges, including opportunities for policy change advocacy.

Learning Objectives:

At the completion of this activity, participants should be able to:
  • Describe ways that insurance plans vary in CGM formulary coverage, including differences in coverage and utilization management by brand/device type.
  • Describe insurance plan CGM coverage criteria, how to find criteria, and patient impact when criteria is not aligned with evidence.
  • Apply understanding of navigating CGM coverage variability to DCES patient education activities and advocacy for policy solutions.
Disclosure(s):
Amy Killelea, JD: No financial relationships to disclose
Zeynep Celik, MIDP: No financial relationships to disclose