The source from which patients receive their continuous glucose monitoring (CGM) supplies matters — far more than many realize.
When patients receive their CGM supplies through durable medical equipment (DME) providers instead of through pharmacies, they have higher adherence rates, and their total health-care costs are lower. Overall health-care utilization is lower, too.
These are just some of the key findings highlighted in recently published research from the journal Clinical Diabetes.
“The results from this analysis align with a previous study demonstrating significantly higher CGM adherence and substantially lower total health-care costs among patients who obtained their CGM devices and supplies through a DME supplier compared with those who received them through a pharmacy,” researchers wrote.
The research also touched on payer decisions and policy implications related to CGM devices.
Broadly, better adherence equates to better outcomes and lower costs. CGM devices are most effective when used consistently, and DME providers appear to be more successful in supporting patient adherence compared to other options.
After one year, Medicare and Medicare Advantage (MA) patients had a 78% adherence rate with DME compared to a 64% rate through pharmacies, according to the research. For commercially insured patients, that split was 60% with DME and 48% for pharmacies.
Adherence rates were better for DME-sourced CGM across payer types over shorter periods as well.
“Higher adherence rates with continuous glucose monitors are directly linked to improved glycemic control, reduced complications and lower health-care costs,” Dr. Steven Edelman, a professor of medicine at the University of California San Diego, said in a related press release. “This latest research emphasizes the need for industry-wide support of evidence-based decisions that optimize patient access to diabetes technology and improve clinical outcomes.”
In terms of health-care dollars, Medicare and MA DME users consistently had lower total costs than pharmacy users. At 12 months, for example, DME CGM users had a total cost of $11,154, which compares to $15,029 for pharmacy-sourced CGM.
Costs for commercial patients were not compared due to variability in plan design.
Additionally, DME users with commercial insurance had significantly fewer ER visits and inpatient days at all time points. For Medicare and MA patients, DME users also had lower utilization, but the differences weren’t statistically significant.
Contextually, the research comes at a critical time.
An increasing number of payers are shifting CGM coverage from DME to pharmacy channels to reduce paperwork and access delays.
“Although the DME suppliers’ business model emphasizes ongoing engagement and support, some payer groups, including some Medicare Advantage plans, commercial insurers and state Medicaid programs, have begun shifting CGM coverage to the pharmacy benefit (either as an expansion of access or a substitution for the DME supplier),” researchers noted.
Doing so, however, could unintentionally reduce adherence and increase long-term costs.
CCS, a provider of clinical solutions and home-delivered medical supplies for those living with chronic conditions, contributed to and funded the research.
“This research presents an opportunity to align health plan policies with provider preferences based on measurable outcomes. The data shows patients utilizing DME providers experience higher adherence rates, reduced health-care costs and fewer emergency interventions compared to pharmacy channels,” Dr. Arti Masturzo, CMO at CCS, said in the release. “By focusing on these evidence-based results, we can work toward building a health-care system where patients receive better diabetes management support while reducing costs for the entire system.”
To explore how the source of CGM supplies impacts patient outcomes, the researchers conducted a retrospective, matched-cohort analysis using a large national claims database. They focused on adults with diabetes who were new to CGM therapy.
Researchers pulled data from the Mariner Commercial Claims Database, which includes over 75 billion insurance claims from 161 million patients across the U.S.
