10/04/2024

Study Finds Better Adherence and Lower Costs for CGMs Supplied Under Medical Benefit

Source:  AAHomecare Insider 10/02/2024

A new study published in the Journal of Medical Internet Research Diabetes finds that individuals with diabetes who receive their Continuous Glucose Monitors (CGMs) under the DME benefit have better adherence rates than those who get their CGMs through the pharmacy channel.  The study also shows a considerably lower overall cost of care for patients covered under the DME benefit.
 
The peer-reviewed study, Exploring the Impact of Device Sourcing on Real-World Adherence and Cost Implications of Continuous Glucose Monitoring in Patients With Diabetes: Retrospective Claims Analysis, specifically finds that:

• Patients covered under the DME benefit had 23% greater adherence than those on the pharmacy benefit.
• The DME benefit shows a higher rate of therapy reinitiation in non-adherent patients (22%), while pharmacy benefit was only 10%.
• Mean annual total medical costs for adherent patients in the pharmacy cohort were 53% higher than the DME cohort – $10,635 for pharmacy vs. $6,967 under DME.

The study was led by CCS Medical and was co-authored by medical experts from the University of Rochester, North Carolina State University, and Generativity Health Economics and Outcomes Research.

“CGMs are only effective if people use them,” said Dr. Arti Masturzo, Chief Medical Officer at CCS. “This first-of-its-kind research demonstrates that a physician’s decision to direct a patient to use their medical benefit instead of their pharmacy benefit when accessing a medical device can seriously impact health outcomes and costs of care. Data-driven insights like this are highly valuable to clinicians and care teams who are the first line of defense when it comes to improving patient outcomes and reducing waste in our healthcare system.”

Findings from the new study will be a considerable asset in advocacy with policymakers and payers for keeping CGM coverage under the DME benefit.

See the study here.