Coverage and Benefit Design

Pharmacy professionals and a payer representative convened an expert panel to connect available evidence and the panelists’ extensive experiences on the value of RT-CGM in improving patient quality of life. In addition, the panelists provided prac­tical approaches to bring awareness, accessibility, and the utility of rtCGM to positively impact patient quality of life in practical applications. Managed care and payer professionals will find these real-world insights useful in characterizing the value of RT-CGM in health plan populations when making coverage determinations.

“Real-Time Continuous Glucose Monitoring: Timely Opportunities to Improve Quality of Life.” CGM Live Virtual Crossfire Series Recap. Part 2. Pharmacy Times Continuing Education. August 2021.

An expert panel composed of pharmacists and a payer professional discussed the value of RT-CGM and the role pharmacists and pharmacy technicians have in optimizing diabetes management. By making RT-CGM available to and allowing pharmacy professionals to work alongside patients, health care stakeholders can leverage the information offered by this technology to optimize diabetes management and mitigate disease impact. The panelists noted that coverage of RT-CGM through the pharmacy benefit facilitates access by allowing patients to fill their prescription directly at community pharmacies. The panelists’ insights are of use to managed care and payer professionals in determining optimal coverage policies for RT-CGM to improve outcomes among members with diabetes.

“Real-Time Continuous Glucose Monitoring: Implications for Pharmacists.” CGM Live Virtual Crossfire Series Recap. Part 1. Pharmacy Times Continuing Education. May 2021.

A roundtable convened by the American Pharmacists Association reviewed the substantial body of evidence demonstrating that CGM is associated with improved glycemic control for patients with both T1D and T2D. Leading experts participating in the roundtable noted that CGM remains underutilized and that disparities in care are evident. One specific barrier to expanded utilization called out by the participants was the lack of an adequate number of providers who offer the service. Developing community pharmacy-based CGM services has been proposed as a logical solution for expanding patient access. Supporting this approach are the abundant data showing that pharmacist involvement in patient care for diabetes improves outcomes and reduces overall costs of care. Managed care and payer professionals will find this in-depth review and discussion valuable for developing their own policies for CGM coverage and access in the pharmacy setting.

American Pharmacists Association Foundation. “Expanding Access to Continuous Glucose Monitoring Technology in Community Pharmacies.” Practices Insights. May 2022.