What You Should Know:
– Medicare has significantly expanded access to the Eversense E3 continuous glucose monitoring (CGM) System, a long-lasting and implantable option that offers several advantages over traditional CGMs.
– Medicare has significantly expanded access to the Eversense E3 CGM System, the longest-lasting continuous glucose monitor available, with the implementation of Local Coverage Determinations providing access to implantable CGM for basal-only patients, by the first three Medicare Administrative Contractors (MACs).
– The Medicare expansion is expected to benefit millions of Americans who rely on Medicare for their diabetes care. The earliest MAC expansion becomes effective on February 25, 2024, and the companies expect the remaining MACs to finalize their expansion soon.
Long-Lasting CGM System for People with Diabetes
Previously, only people with diabetes who required multiple daily insulin injections were eligible for Medicare coverage of implantable CGMs. This new policy removes that restriction, making the Eversense E3 accessible to all insulin users as well as non-insulin users with a history of problematic hypoglycemia.
The Eversense E3 is unique because it offers:
- Up to 6 months of sensor wear compared to the usual 2-week lifespan of traditional CGMs, reducing the need for frequent insertions and replacements.
- Exceptional accuracy with a demonstrated mean absolute relative difference (MARD) of 8.5%.
- A removable transmitter that allows users to take it off without wasting a sensor or waiting for a warmup period.
- Predictive on-body alerts to help prevent critical events, especially during sleep or when away from a phone.
This expansion is a positive step towards improving diabetes management for Medicare beneficiaries. It provides them with greater choice and flexibility in their CGM options, potentially leading to better outcomes and quality of life.
“We welcome this policy change and look forward to bringing this differentiated CGM option to millions of more Americans through Medicare,” said Rudy Thoms, VP, CGM Commercial US of Ascensia Diabetes Care, a subsidiary of PHC Holdings Corporation (TSE 6523). “Eversense E3 is a truly unique technology and optionality is key in diabetes care, where what works for one person does not always work for all. In particular, our Medicare users love that this twice-yearly CGM offers them unparalleled reliability and flexibility, without the burden of regular self-insertions and the constant reordering of supplies. It is important that people with diabetes have the same access to the benefits of a fully implantable, long-term CGM, as they do to traditional CGMs [that have a much shorter lifespan], and so we are thrilled to see this expansion.”
