A new law establishes a durable medical equipment (DME) and a pharmacy benefit for continuous glucose monitors (CGMs) provided via the Arizona Health Care Cost Containment System (AHCCCS), the state’s Medicaid agency.
SB 1132 “requires contractors with the AHCCCS to provide AHCCCS members with continuous glucose monitors and outlines requirements related to coverage criteria for continuous glucose monitors,” a fact sheet for the bill said. Contractors will be required to “provide AHCCCS members with CGMs through a pharmacy benefit and a durable medical equipment benefit; and allow a member’s prescribing provider to determine the appropriate CGM for the member.”
The new law also “specifies that the criteria for CGM coverage must be consistent, regardless of whether the monitor is received as a pharmacy benefit or a durable medical equipment benefit.”
Gov. Katie Hobbs signed SB 1132 into law on May 13.
In a May 21 bulletin, the American Association for Homecare (AAHomecare) called the new law “a step forward in diabetes care and patient choice,” in part because “prescribing providers will have the authority to choose the most appropriate channel for each patient.”
AAHomecare also applauded the law’s requirement that “coverage criteria for CGMs will be aligned with current standards of care, and consistent across both benefit types.”
Recent research published in Clinical Diabetes, the journal of the American Diabetes Association, demonstrated that the method of CGM provision — DME providers vs. pharmacies — significantly impacts patient outcomes. The study’s authors said patients who received CGM supplies through a DME provider were more adherent to their diabetes treatment regimens.
“This win will help people living with diabetes and the DME community, reinforcing the role of HME [home medical equipment] providers in delivering critical technology and service to patients,” AAHomecare said. The association’s payer relations team “worked with the diabetes council advocating for this legislation.”
