Request for cgms: denied by insurance

I have been both personally and professionally affected by the ongoing denial of CGM coverage by medical insurance companies.

I have felt, since the first time I wore a CGM system, that this technology represented an astounding leap forward in the management of diabetes. To know what food, exercise, sleep, sex, stress, etc, etc, etc, actually does to blood sugar, was like lifting a veil that had covered my diabetes management for the previous 28 years. Finally, I really knew what “active insulin” means!

Personally, CGM was important enough to me that, in 2006 I requested coverage of CGM by the Employee Health Plan, of a US News and World Report top 3 US hospital. This eventually lead to paying out of pocket for said system. Later, Harvard Pilgrim Health Care issued a statement saying: “the ADA issued a 2007 position statement concluding that although the CGM system may be used to determine blood sugar patterns and detect unrecognized hypoglycemia, its role in improving diabetes outcomes has not been established.” Despite requesting coverage of ongoing sensor use, HPHC has issued a blanket policy, eliminating coverage of all aspects of CGM. Personally, CGM has lead to an improved diabetes outcome. I recognize symptoms much earlier and correct what was, previously a significant high or low blood sugar. If the “area under the curve” of abnormal blood sugar (or % time hyper or hypo) is reduced, then long term control is better and microvascular complications are reduced (improved diabetes outcome). The goal is not a normal HbA1c, it is normal blood sugars.

Professionally, I have watched numerous patients be denied coverage of CGM. I am lucky that I have avoided complications, but many of these people have lost their independence due to the ravages of diabetes. Fear of hypoglycemia is a powerful feeling and leads many to chronic, poor control and complications. Reduction of this fear leads to better long term control and microvascular complications are reduced (improved diabetes outcome).

As an example, I will tell you about the first patient I attempted to obtain CGM coverage for. She was 30 years old, a first grade teacher, and a mother of 2 and 4 year old boys. She had been diagnosed with diabetes right around the same time as me and we were roughly the same age. Through no fault of her own, she had developed a terrible complication of bovine insulin, from treatment with this in the late 70’s to mid 80’s. We all develop antibodies to insulin, which may or may not make it less effective, but she had developed a profound immune response to beef insulin, that rendered insulin action very unpredictable, even when using insulin analogues. Insulin, when absorbed, was bound (in her blood) to antibodies and could randomly be “released,” becoming free to act and cause severe lows. When she came in for appointments, I asked “how many glucagons since your last visit?” Routinely, the answer was in the teens. She ended up running herself high, for the majority of her twenties, to try and avoid these swings in blood sugar. When I met her, she had 5 grams of proteinuria and was undergoing bilateral vitrectomies. I thought, here is the place where we can do tangible good for a patient. I appealed to the insurance company, not only for her own health, but for the safety of her 1st graders and her two boys, to cover her CGM. This was clearly life saving, and yet it was denied. If saving lives is not an improved diabetes outcome, then it is clear that priorities are misplaced in the people making these decisions for the insurance companies.

I raise my voice, because my REQUEST FOR CGMS: has been DENIED BY INSURANCE!!!

I wore a CGM for a year as part of the “artificial pancreas” study. It was the only way that I could afford the supplies (they were free in the study). My A1C went from 8.1 to 7.0 in about 5 months. It was incredible. I hope that once the findings of this study are published, the insurance agencies will start covering the CGMs.