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

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.