Evidence

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

August 30, 2023

Coverage and Benefit Design

Webinar / Archive

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.

Evidence-Based Rationale for Expanding Access to CGM in Individuals with Type 2 Diabetes Treated with Nonintensive Therapies

August 3, 2023

Clinical Outcomes

Article / Publication

This article reports key findings from recent randomized, observational, and retrospective studies investigating use of CGM in type 2 diabetes (T2D) individuals treated with basal insulin only and/or noninsulin therapies. Data from 29 studies were reviewed and analyzed. Both randomized and prospective/retrospective studies have demonstrated significant glycemic improvement, reductions in diabetes-related events and hospitalization rates, and cost benefits of persistent CGM use by individuals with T2D who are treated with basal insulin only, basal plus noninsulin medications, and noninsulin medications without insulin. In 23 (79%) of the 29 studies reviewed, investigators reported associations between CGM and improvements in HbA1c and/or key CGM metrics. These findings, alone, provide strong evidence that supports providing access to this technology to those with T2D who are less intensively treated. The narrative presents an evidence-based rationale for expanded access to CGM within the T2D basal insulin only and/or noninsulin treated population. Recent clinical guidelines from the American Diabetes Association and American Association of Clinical Endocrinology now endorse CGM use in individuals treated with nonintensive insulin regimens. Access in the basal insulin only population has expanded since the start of this project. CGM should be made readily available to all individuals with diabetes who are able to use this technology safely and effectively.

Addressing Disparities in Diabetes Care Quality with CGM

July 14, 2023

Population Health

Infographic

This infographic highlights the value of CGM for positively impacting diabetes care quality, with special consideration given to underserved demographics of patients based on race/ethnicity and age. The piece links to the 2023 AMCP symposium moderated by Dr. Gary Puckrein, President and Chief Executive Officer of the National Minority Quality Forum, where diabetes care disparities and quality were also brought into focus. Also linked is an expert interview with Diana Isaacs, PharmD, with insights on disparities in diabetes care and quality considerations. Guidance is offered on improving CGM access as a means for meeting recent HEDIS quality measures tied to reducing emergency department and hospital use. Using findings from Blue Cross Blue Shield North Carolina as a case study, the infographic serves as a call-to-action for payers to remove manual prior authorizations for CGM under the pharmacy benefit.

Innovations in rtCGM to Improve Clinical Outcomes in Diabetes

July 14, 2023

Clinical Outcomes

CE Activities

Intended Audience: This activity is designed to meet the educational needs of medical directors, registered nurses, pharmacy directors, clinical pharmacists, specialty pharmacists, quality directors, as well as network physicians affiliated with various MCOs, health systems, and other payer organizations.

Credit Available: Up to 1.5 credit hours available for nurses (ANCC), pharmacists (ACPE), and physicians (AMA PRA Category 1 Credit™)

Expiration Date:  October 31, 2024

Educational Objectives
After completing this activity, the participant should be better able to:

• Assess clinical evidence and professional society guidelines for CGM systems in patients with type 1 or type 2 diabetes
• Characterize the impact of rtCGM on clinical measures of diabetes care
• Implement medical and pharmacy benefit design strategies to support appropriate access to rtCGM and develop evidence-based clinical criteria

Expert Faculty

Matthew D. Harman, PharmD, MPH
VP, Clinical Solutions, Employers Health

Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES, FADCES, FCCP
Endocrine Clinical Pharmacy Specialist, Co-Director, Endocrine Disorders in Pregnancy
Cleveland Clinic Endocrinology & Metabolism Institute

Gary A. Puckrein, PhD
President and Chief Executive Officer, National Minority Quality Forum

Drake Reiter, PharmD
Advisor, Pharmacy Product & Trend, Priority Health

Jointly provided by Impact Education, LLC, and Medical Education Resources.
This activity is supported by an independent educational grant from Dexcom, Inc.