AMCP Market Insights Health Plan Best Practices: Implementing Continuous Glucose Monitoring Interventions to Improve Outcomes for Members with Diabetes

CGM has advanced diabetes management, with demonstrated improvements in glycemic management, reduction of hypoglycemia-related resource utilization, and enhanced member engagement and self-management. While this technology was initially prescribed predominantly for those living with type 1 diabetes (T1D), the mounting body of evidence and expert recommendations have led to more widespread use in insulin-treated T2D, necessitating the implementation of evidence-based benefit design policies by health plans. During this working group meeting, leading payer and managed care decision makers reviewed recent findings and shared their insights on best practices for CGM coverage and reimbursement, including alignment with clinical practice guidelines, availability under the pharmacy benefit, and automated adjudication at the point of sale.

Jim Kenney, RPh, MBA (Moderator) Founder and President JTKenney, LLC	Sheri Dolan, BSPharm Clinical Pharmacist, Healthcare and Family Services Bureau of Professional and Ancillary Services University of Illinois at Chicago
Thomas Grace, MD Medical Director Blanchard Valley Diabetes Center	Estay Greene, PharmD, MBA Vice President of Pharmacy Zing Health
Eric Long, PharmD, MBA Disease Management Pharmacist Beacon Health System	Scott McClelland, PharmD Vice President, Commercial and Specialty Pharmacy Programs Florida Blue
Josh Moore, PharmD Director of Pharmacy MO HealthNet Division Missouri Department of Social Services	Diane E. Morgan, PharmD Director, Specialty Pharmacy Government Programs Pharmacy UnitedHealthcare
Heather Mullins, PMP Senior Clinical Program Manager UnitedHealthcare	Susan Wescott, RPh, MBA Executive Lead, Clinical Services, Alluma, LLC Senior Director of Pharmacy, Managed Care, Mayo Clinic

In support of this working group, a survey of managed care professionals was conducted. Click here to download the results.