Lost in Translation: A Disconnect Between the Science and Medicare Coverage Criteria for Continuous Subcutaneous Insulin Infusion

Parkin, Christopher G.; Carlson, Anders; Galindo, Rodolfo J.; Kruger, Davida F.; Levy, Carol J.; Umpiérrez, Guillermo E.; Forlenza, Gregory P.; McGill, Janet B.

doi:10.1089/dia.2021.0196

Cited by 7 publications

(4 citation statements)

References 108 publications

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“…A recent pair of publications examined the Centers for Medicare and Medicaid Services coverage criteria for insulin pumps and CGMs. 122 , 123 These commentaries call for coverage criteria based on modern device use profiles and evidence-based requirements. They also note the demonstrated cost effectiveness of CGM and CSII technologies.…”

Section: Expert Opinion On Potential Solutionsmentioning

confidence: 99%

Barriers to Uptake of Insulin Technologies and Novel Solutions

PAULEY¹,

Berget²,

Messer³

et al. 2021

MDER

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Section: Expert Opinion On Potential Solutionsmentioning

confidence: 99%

Barriers to Uptake of Insulin Technologies and Novel Solutions

PAULEY¹,

Berget²,

Messer³

et al. 2021

MDER

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“…The CMS’s coverage of glucose testing supplies is not aligned with eligibility requirements for diabetes devices. More importantly, eligibility requirements and coverage lag behind the evolving evidence of their effectiveness ( 15 , 16 ).…”

Section: Focus Area 2: Diabetes Devicesmentioning

confidence: 99%

The National Clinical Care Commission Report to Congress: Leveraging Federal Policies and Programs to Improve Diabetes Treatment and Reduce Complications

Greenlee¹,

Bolen

Chong

et al. 2023

Diabetes Care

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The Treatment and Complications subcommittee of the National Clinical Care Commission focused on factors likely to improve the delivery of high-quality care to all people with diabetes. The gap between available resources and the needs of people living with diabetes adversely impacts both treatment and outcomes. The Commission’s recommendations are designed to bridge this gap. At the patient level, the Commission recommends reducing barriers and streamlining administrative processes to improve access to diabetes self-management training, diabetes devices, virtual care, and insulin. At the practice level, we recommend enhancing programs that support team-based care and developing capacity to support technology-enabled mentoring interventions. At the health system level, we recommend that the Department of Health and Human Services routinely assess the needs of the health care workforce and ensure funding of training programs directed to meet those needs. At the health policy level, we recommend establishing a process to identify and ensure pre-deductible insurance coverage for high-value diabetes treatments and services and developing a quality measure that reduces risk of hypoglycemia and enhances patient safety. We also identified several areas that need additional research, such as studying the barriers to uptake of diabetes self-management education and support, exploring methods to implement team-based care, and evaluating the importance of digital connectivity as a social determinant of health. The Commission strongly encourages Congress, the Department of Health and Human Services, and other federal departments and agencies to take swift action to implement these recommendations to improve health outcomes and quality of life among people living with diabetes.

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“…However, not all these criteria are evidence-based and they may pose challenges for patients from disadvantaged backgrounds who may have more barriers to care and social determinants of health. While clinical guidelines have broadened their criteria for use [4][5][6], many insurance providers continue to have restrictive criteria resulting in a major barrier for many patients [35][36][37][38][39]. From the provider's perspective, a lack of infrastructure or support staff in clinics to address the multifaceted requirements of prescribing and managing patients with diabetes technology (such as handling insurance prior authorizations, providing diabetes education, and downloading reports etc.)…”

Section: System-level Barriersmentioning

confidence: 99%

Addressing disparities in technology use among patients with type 1 diabetes: a review

Kanbour,

Everett

2023

Current Opinion in Endocrinology, Diabetes &Amp; Obesity

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Purpose of review The benefits of continuous glucose monitors (CGMs) and insulin pumps in the management of type 1 diabetes are widely recognized. However, glaring disparities in access exist, particularly in groups that stand to benefit significantly from diabetes technology use. We will review recent data describing drivers of these disparities and approaches to address the disparities. Recent findings Several qualitative studies were published in recent years that have investigated the drivers of disparities reported over the past decades. These studies report that in addition to typical barriers seen in the diabetes technology, these patients have unique challenges that make insulin pumps and CGMs less accessible. Summary Barriers to technology use in these groups include stigmatization, lack of support, and financial constraints, provider biases, stringent insurance policies and clinic infrastructure. To address these inequities, multifaceted strategies across community, healthcare, and provider sectors are essential. Key initiatives include enhancing public awareness, refining health policies, ensuring access to high-quality care, and emphasizing patient-centered approaches. The equitable use of technology can further narrow the gap in T1D outcomes. The social and economic implications of suboptimal T1D management further underscore the urgency of these efforts for both improved health outcomes and cost-efficient care.

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Lost in Translation: A Disconnect Between the Science and Medicare Coverage Criteria for Continuous Subcutaneous Insulin Infusion

Cited by 7 publications

References 108 publications

Barriers to Uptake of Insulin Technologies and Novel Solutions

Barriers to Uptake of Insulin Technologies and Novel Solutions

The National Clinical Care Commission Report to Congress: Leveraging Federal Policies and Programs to Improve Diabetes Treatment and Reduce Complications

Addressing disparities in technology use among patients with type 1 diabetes: a review

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