Cgm issue

I am on Medicare ,I take metformin,tresiba and trulicity. I am type 2. Any hope of a cgm? I have been told no to a Libre. Nancy50

If your test results indicate your BGs are out of control or your c-peptide results are low, your doctor can make a case to cover a CGM

My wife is T2 and in reasonably good control, but her endo was able to convince Aetna to cover Libre. I’m not sure what argument he used, but most experienced and supportive doctors know how to play the insurance game.

I am 6.5,eye doctor wants it lower. I come close to a low with exercise 60’s 58. I am very active. I wonder about a c-peptide ,had one 30 years ago. It was on the lower end. It is so frustrating. The other part is I have vision issues. Just makes me mad. Nancy50

Hi Nancy:

Medicare really does not care if you are Type 1 or 2 or any other type for that matter. Please see below what your doctor has to certify to place you on a Dexcom CGM.

One of the requirements is “intensive insulin therapy” which is defined as 3 or more injections per day or a pump. Have you ever discussed mealtime insulin with your doctor?

I begged to see the endo last fall. He said I am lucky to have no complications. I said I have worked hard. He told me the trulicity is what is keeping me off of meal time insulin. I see a CDE, I will push as I also have tremors in my right hand ,on and off. I just get angry that I work so hard and they say no. Thank you. Nancy50

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If it was me, I’d be looking for a new endo.

Living in a rural area, no other.

Nancy Matulis

I am in rural Massachusetts, about 85 mile drive to Boston but it is totally worth it to get great care.

Have you considered an online endocrinologist? I know nothing about them beyond their practices all seem to be growing very fast. Then of course there those online that specialize in a standardized treatment program such as

I grew up in the Worcester area. Other endos that you can get into are hours away here in Maine.

Nancy Matulis

  • The beneficiary is insulin-treated with 3 or more daily injections (MDI) of insulin or a continuous subcutaneous insulin infusion (CSII) pump; and,
  • The beneficiary’s insulin treatment regimen requires frequent adjustments by the beneficiary on the basis of therapeutic CGM testing results.
    I have 1a day,1 a week. Nancy50

So no, you then don’t qualify at this time unless you change your treatment which only makes sense if what you are currently doing does not work sufficiently well for you.

The key requirement for medicare appears to be mealtime insulin. You could talk with your doctor about lowering a1c, and determine if adding that is appropriate for you, and prescribes it. Then you would meet medicare rules.

Will your opthomolgist consider approving it? Or at least talking to your endo about his/her concerns?

Thank you everyone for your comments. I will reach out to my team. Nancy50