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Endocrinology, Diabetes, and Metabolism | Medical Education | Pharmacy and Pharmaceutical Sciences
Home glucose monitoring was revolutionized in 1999 when the U.S. Food and Drug Administration (FDA) approved the first professional continuous glucose monitor (CGM). With the advancements in technology, newer CGMs are available for personal use and have greatly impacted the way diabetes is managed. Although there are data regarding the benefits of CGMs in lowering hemoglobin A1c, data is currently lacking regarding whether the use of CGM affects the number of hospitalization/emergency department visits as well as the effect on cost of care. In addition, while CGMs have been traditionally used in patients with type 1 diabetes due to their insulin necessity, they have also shown benefit in patients with type 2 diabetes on basal-bolus insulin therapy. According to Ruedy et al, “Continuous Glucose Monitoring in Older Adults with Type 1 and Type 2 Diabetes using Multiple Daily Injections of Insulin”, use of CGMs was associated with improvements in hemoglobin A1c as well as reduction in glycemic variability. Criteria for coverage of CGMs for Medicare beneficiaries is outlined in the Local Coverage Determination (LCD) L33822 “Glucose Monitors;” use is restricted to patients with diabetes using multiple daily insulin injections that had been testing blood sugar at least four times per day with traditional finger stick tests. On March 30th, 2020, the Centers for Medicare and Medicaid Services (CMS), in response to the COVID-19 Public Health Emergency (PHE), issued a memo allowing Medicare plans to relax requirements on coverage of CGMs to provide better access. At this time, PHA lifted the prior authorization requirement on the preferred therapeutic CGM (Dexcom®) for Medicare beneficiaries. The purpose of this study is to explore the effects of the PHE removal of PA on utilization of CGMs, impact on management of diabetes, and total cost of care related to diabetes. This is a single institution, retrospective data and chart review of PHA Medicare members with a diagnosis of diabetes utilizing a CGM and continuous enrollment from April 2019 through March 2021. Patients were identified using eligibility information, primary ICD-10 codes for diabetes (type 1 diabetes, type 2 diabetes, or other diabetes), and if members had a claim for a CGM from April 2020 through March 2021. The primary outcome is the utilization of CGM and total cost of care related to diabetes to the health plan and members pre and post removal of PA. The secondary outcomes include member’s hemoglobin A1c and number of hospitalization/ED visits related to diabetes pre and post removal of PA. The outcomes will be compared against two different reporting periods: the baseline reporting period from April 2019 through March 2020 and the comparator reporting period from April 2020 through March 2021. Data regarding utilization, cost, hospitalization/ED visits, and adherence will be pulled from claims data. Chart review will be conducted for Medicare members with access to electronic medical records (EMR) to analyze hemoglobin A1c. Results and conclusions will be shared when the project is completed. (IRB Approved)
Kidney & Diabetes
Graduate Medical Education
Conference / Event Name
Academic Achievement Day, 2022
Abe, Momoka; Norton, Katie; and Smith, Jenifer, "The impact of a Medicare Public Health Emergency policy change for continuous glucose monitors on utilization and total cost of care for diabetes" (2022). Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2022. 17.