DeGette, Bilirakis call on VA to expand access to Continuous Glucose Monitors for veterans with diabetes

WASHINGTON, D.C. – The co-chairs of the Congressional Diabetes Caucus, U.S. Reps. Diana DeGette (D-CO) and Gus Bilirakis (R-FL), sent a letter today to the head of the Department of Veterans Affairs calling on the agency to revise its current coverage criteria for Continuous Glucose Monitors so that more veterans with diabetes can access the promising new technology that’s helping millions of people across the country better manage the disease.

The request comes in response to a recent decision by the Centers for Medicare and Medicaid Services to cover the cost of Continuous Glucose Monitors for patients covered by Medicare, regardless of how often they are required to use insulin.

Under current Veterans Health Administration guidelines, continuous glucose monitors are offered only to veterans who are required to inject insulin at least three times a day. In urging the administration to make the monitors available to all veterans with diabetes the lawmakers point to the growing amount of research that shows patients, regardless of how often they take insulin, are benefitting from the use of continuous monitors that show their glucose levels in real time to help them better manage the disease.

“The overwhelming consensus was that there is clinical benefit for persons with diabetes mellitus administering basal insulin to use [Continuous Glucose Monitor] technology to manage their diabetes,” the lawmakers wrote to VA Secretary Denis McDonough. “For these same reasons, we urge you to replicate [Medicare’s] coverage change for veterans by eliminating requirements that veterans ‘require an intensive insulin regimen (e.g. ≥3 injections/day, or insulin pump) to achieve desired glycemic control.’”

Continuous Glucose Monitors are small devices, usually inserted under the skin of an individual with diabetes, that continuously monitor their blood glucose levels throughout the day and night. The devices provide alerts and real-time information regarding an individual’s blood glucose levels, often through an app that’s been downloaded on their smartphone.

By using the monitors, individuals living with diabetes can significantly reduce the need for fingerstick testing, and the real-time information that’s provided to them by the device can help them make more informed decisions to better manage the disease.

More than one in ten Americans has already developed Type 2 diabetes. The rate among veterans, however, is even higher with nearly 25% of America’s veterans now affected by the disease.

Diabetes is the most common reason for a veteran to be admitted to a VA hospital. It is also the leading cause of blindness and amputations for VA patients.

By ensuring that America’s veterans have access to the same continuous monitoring technology that’s helping other patients across the country better manage the disease, DeGette and Bilirakis are hoping to prevent these devastating outcomes for more veterans and help improve their overall quality of life.

“Together we can help ensure that veterans with diabetes have access to the full range of devices and technologies that they need to manage their conditions,” the lawmakers wrote. “This access will help improve their quality of life and even holds the potential to reduce health care costs.”

The text of the lawmakers’ letter to Secretary McDonough is below, and a copy of the letter is available here:

May 17, 2023

The Honorable Denis McDonough

Secretary 

U.S. Department of Veterans Affairs 

Veterans Affairs Building, Room 1000

810 Vermont Avenue, N.W. 

Washington, D.C. 20571 

Dear Secretary McDonough:

As Co-Chairs of the Congressional Diabetes Caucus, we write to urge you to review current Veterans Health Administration criteria for coverage for continuous glucose monitors (CGMs) in light of recent changes to Medicare’s coverage policies to ensure that veterans have access to the diabetes management technologies that they need.

We support recent changes to Medicare coverage policy for CGMs that permit Medicare beneficiaries treated with insulin or with a problematic history of hypoglycemia, regardless of how often they inject insulin, to be eligible for CGM coverage. We support these policy changes because they were based on a thoughtful and thorough review of available peer reviewed research on the effect of CGM use on HbA1c and/or Time in Range (TIR) in persons with diabetes mellitus, as well as on the American Diabetes Association’s (ADA) most recent Standards of Medical Care and the American Association of Clinical Endocrinology’s (AACE) most recent Clinical Practice Guideline on the use of Advanced Technology in the Management of Persons with Diabetes Mellitus. The overwhelming consensus was that there is clinical benefit for persons with diabetes mellitus administering basal insulin to use CGM technology to manage their diabetes.

For these same reasons, we urge you to replicate this coverage change for veterans by eliminating requirements that veterans “requires an intensive insulin regimen (e.g. ≥3 injections/day, or insulin pump) to achieve desired glycemic control (target range) ….”

We appreciate the on-going efforts of the Veterans Health Administration (VHA) to provide more efficient and effective health care services to our growing veteran populations. While the agency has made good strides toward that end, we are concerned about achieving greater parity between federal health programs to ensure that our veterans enjoy the benefits afforded to Medicare beneficiaries.

Together we can help ensure that veterans with diabetes have access to the full range of devices and technologies that they need to manage their conditions. This access will help improve their quality of life and even holds the potential to reduce health care costs. Thank you for your attention to this issue.

Sincerely,