TRICARE must update its policy on coverage for continuous glucose monitors (CGMs) to keep up with recent changes made by major providers – and to ensure coverage keeps up with new technologies, treatment protocols, and benchmarks established by high quality commercial plans and other government payers.

MOAA’s work to protect the value of this service-earned benefit included a letter addressing needed CGM changes to DoD health care leadership from The Military Coalition (TMC), a group of 35 organizations representing about 5.5 million members of the uniformed services community, including servicemembers, retirees, veterans, their families, and survivors. MOAA co-chairs several TMC committees (including the Health Care Committee) and took lead on the letter.

At issue: The Centers for Medicare and Medicaid Services (CMS) and the VA recently expanded coverage for CGMs to generally cover anyone with diabetes being treated with daily insulin. TRICARE policy still requires individuals to self-test blood glucose at least four times a day and to undergo multiple daily insulin injections or insulin pump therapy to qualify for CGM coverage.  

CGMs have become essential for effectively monitoring and managing blood glucose levels. CGM systems track blood sugar levels day and night, intermittently collecting readings automatically. Data collected from CGMs can help detect trends and patterns that help patients and medical providers better manage diabetes or other medical conditions.

[RELATED: MOAA’s TRICARE Guide]

While the initial rise in CGM adoption likely will lead to increased costs in the short term, there are potential long-term savings through improved health outcomes and fewer high-cost interventions such as hospitalizations, plus improved quality of life for insulin-dependent TRICARE beneficiaries.

Because CGMs are relatively new technology, coverage policy continues to evolve across all payers as new data becomes available. MOAA monitors for policy changes and has successfully advocated for past fixes to TRICARE CGM policy, such as the reversal of 30-day refill limits on transmitters and sensors.

We will continue to work with TMC and others to ensure TRICARE eligibility for CGMs is updated as coverage benchmarks evolve.