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.

We value your privacy. We use cookies and other technologies to keep the web site reliable and secure, tailor your experience, and measure web site performance, as described in our Privacy Policy.


OSP Technical Support