Table 3.
CGM Eligibility Criteria for Selected States.
| Criteria | T1D | T2D | GDM | ≥3 daily injections or insulin pump a | BGM ≥4 times daily | HbA1c ≥7% b | Frequent severe hypo (<50mg/dL) | Hypoglycemia unawareness | History of hyperglycemia c | Nocturnal hypoglycemia | DKA | Preprandial-postprandial hyperglycemia | Dawn phenomenon | Benefit |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Arkansas | Yes | Yes | Yes | Yes | Yes | DME | ||||||||
| Georgiad,e | Yes | Yes | Yes | Yes | Yes | Yes | Yes | DME | ||||||
| Idaho | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | DME | |||
| Kentucky a | Yes | Yes | Rx | |||||||||||
| Michigan | Yes | Yes | Yes | Yes | Yes | DME | ||||||||
| Missouri | Yes | Yes f | Yes f | Yes a | Rx | |||||||||
| Nevada | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Rx | ||||||
| New Hampshire | Yes | Yes | Yes | Yes | Yes | Yes | Rx | |||||||
| New York e | Yes | Yes | Yes | Yes | Yes | Rx | ||||||||
| Oklahoma | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Rx | ||||
| Rhode Island | Yes | Yes | Yes | Yes | Yes | DME |
Abbreviations: CGM, continuous glucose monitoring; GDM, gestational diabetes; BGM, blood glucose monitoring; HbA1c, glycated hemoglobin; DKA, diabetic ketoacidosis; DME, Durable Medical Equipment; Rx, pharmacy benefit.
a
≥3 times daily or insulin pump which may require frequent adjustments.
b
Or not achieving target HbA1c.
c
Including unexplained hyperglycemia.
d
Pediatric coverage only.
e
Prescription by an endocrinologist.
f
Use of rapid-acting insulin is required.