OSP News

BCBSM CGM Coverage Update July 2024

Posted: 07/10/2024

BCBSM/BCN has announced that they will expand their continuous glucose monitor (CGM) coverage to commercial members with type 1 or type 2 diabetes.

Pharmacy Coverage

  • Effective July 1, 2024: MCT2D or PDCM physicians will be added to the approved list of physicians who are eligible for claim payment at the pharmacy for CGM without prior authorization.

DME Coverage

  • Effective July 1, 2024 – August 31, 2024: A prior authorization is still required under the DME benefit, however MCT2D or PDCM participating physicians are exempt from meeting clinical criteria. Physicians must include a comment on the prescription attesting they are MCT2D or PDCM participating for prior authorization approval for members with a diagnosis of type 2 diabetes that fill a CGM for the first time.
  • Effective September 1, 2024: A prior authorization will still need to be submitted with a CGM order. The physician is no longer required to attest to MCT2D or PDCM participation via comment for approval. Prior authorization will be auto-approved based on physician NPI number.

Please note that this change applies only to commercial BCBSM/BCN members and CGMs must be prescribed by an MCT2D physician, this coverage change does not apply to NP/PAs at an MCT2D participating practice.

Click here for more detailed information on these changes.

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