Continuous glucose monitors (CGMs) are an accepted standard of care for treating adults with type 1 and 2 diabetes on insulin therapies. Unlike fingerstick blood glucose monitoring, CGMs offer people with diabetes access to continuous data on their glucose levels — improving clinical quality, health outcomes, and quality of life, as well as reducing health care costs. Traditionally, CGMs have been covered by state Medicaid programs as a durable medical equipment (DME) benefit, but some states have begun offering CGM coverage as a pharmacy benefit to improve access to CGMs for members, align coverage with commercial insurers, and support better utilization tracking, among other benefits.

This checklist outlines practical strategies to support states interested in transitioning CGM coverage from a DME to a pharmacy benefit, as well as states newly implementing CGM coverage and considering doing so as a pharmacy benefit. It includes examples to illustrate successful on-the-ground implementation. The checklist was developed as part of Accelerating Access to Continuous Glucose Monitors in Medicaid to Improve Diabetes Care, an initiative led by the Center for Health Care Strategies through support from The Leona M. and Harry B. Helmsley Charitable Trust.