Which continuous glucose monitor (CGM) is most often covered by insurance?

Insurance Coverage for Continuous Glucose Monitors

The Dexcom G6/G7 and FreeStyle Libre systems are the most commonly covered CGMs by insurance, with both consumer and professional versions covered by most commercial insurance carriers and eligible Medicare programs. 1

Primary Coverage Landscape

Both Dexcom G6/G7 and FreeStyle Libre systems have achieved broad insurance coverage, including Medicare eligibility, making them the most accessible options for patients requiring CGM technology. 1 This represents a significant advantage over other CGM systems that may have more limited reimbursement pathways.

Dexcom G6/G7 Coverage

• The Dexcom G6/G7 real-time CGM system is covered by most commercial insurance carriers and eligible Medicare programs for both consumer and professional versions. 1
• This system is FDA-approved for making treatment decisions without confirmatory blood glucose checks, which strengthens its reimbursement justification. 1, 2
• The Dexcom G6/G7 is approved for use with automated insulin delivery systems, providing additional clinical value that supports insurance coverage. 2

FreeStyle Libre Coverage

• The FreeStyle Libre intermittently scanned CGM (isCGM) is covered by most commercial insurance carriers and eligible Medicare programs. 1
• The direct costs of isCGM are lower than those of real-time CGM systems, which may make it more attractive for cost-conscious payers. 1
• The FreeStyle Libre 2 Plus has FDA approval for use with automated insulin delivery systems, expanding its coverage justification. 2

Clinical Factors Supporting Coverage

FDA Approval Status

• The Dexcom G5/G6 systems have FDA approval for making treatment decisions without confirmatory blood glucose monitoring checks, which is a key factor in insurance coverage decisions. 1, 2
• Factory-calibrated systems like Dexcom G6/G7 and FreeStyle Libre do not require fingerstick blood glucose calibrations, reducing overall monitoring costs. 1

Evidence-Based Benefits

• Real-time CGM in conjunction with intensive insulin regimens lowers HbA1c levels in adults with type 1 diabetes (Grade A recommendation), providing strong evidence for coverage. 1
• Real-world evidence demonstrates that CGM users have meaningful improvements in clinical outcomes and costs, with per member per month savings of $417 for CGM compared to fingerstick glucometers among non-Medicare Advantage patients. 3

Coverage Considerations by Patient Population

Type 1 Diabetes

• Patients with type 1 diabetes on insulin should use the Dexcom G6/G7 for real-time alerts and integration with insulin pumps, which is well-supported by insurance coverage. 2
• Real-time CGM is particularly beneficial and covered for those with hypoglycemia unawareness or frequent hypoglycemic episodes (Grade B recommendation). 1, 2

Type 2 Diabetes

• Patients with type 2 diabetes on multiple daily insulin injections can access coverage for either real-time CGM or intermittently scanned CGM based on need for alerts. 2
• Patients with type 2 diabetes on non-insulin therapy should consider intermittently scanned CGM for cost-effectiveness, though coverage may be more limited in this population. 2

Important Coverage Caveats

Documentation Requirements

• Insurance coverage typically requires documentation that the CGM continuously measured glucose and displayed data in real-time >95% of the time for the duration specified in the product label. 4
• Comprehensive reports and validation of glucose values should be documented in electronic health records to support ongoing coverage. 4

Medicare-Specific Considerations

• While both Dexcom and FreeStyle Libre have Medicare coverage, the cost differential may vary between Medicare Advantage and traditional Medicare plans. 3
• Among Medicare Advantage patients, the cost savings may be less pronounced compared to commercial insurance populations. 3

Alternative Systems with Limited Coverage

• The Senseonics Eversense implantable CGM has FDA approval for use with automated insulin delivery systems but requires a minor surgical procedure for implantation, which may affect coverage decisions. 2
• Other systems requiring fingerstick calibrations (Medtronic Guardian 3, Enlite 2, Dexcom G5) may have different coverage patterns. 1