(1079) The Impact of Expanded Eligibility Criteria on Patients’ Access to Continuous Glucose Monitors and a1c Outcomes at a Federally Qualified Health Center

Objectives: This study aims to evaluate the impact of expanded Center for Medicare & Medicaid Services (CMS) eligibility criteria for initiation of continuous glucose monitors (CGMs). Medicare and Medicaid have recently expanded CGM eligibility criteria in April and June of 2023, respectively, to include all patients with diabetes using insulin injections, regardless of the frequency of injections per day. Prior to this change, requirements included use of basal-bolus insulin four times daily. Due to the relative high cost of CGMs, this technology is typically out of reach for patients whose insurance does not pay for it. Initiation of CGM has been correlated to improvements in hemoglobin A1c. This change has broadened the patient population who can access and benefit from CGMs. The objective of this study is to quantify the number of patients at a federally qualified health center (FQHC) that were able to access CGMs through Medicare or Medicaid insurance before and after the expanded criteria. Additionally, this study will compare the average A1c before and after CGM initiation in patients who were previously eligible and newly eligible.

Methods: This study will be completed via retrospective chart review. Data from a pharmacy at a federally qualified health center (FQHC) will be reviewed for all CGM prescriptions filled 6 months prior to the recent CMS eligibility change up to 6 months after the change (October 16, 2022 – October 16, 2023). Patient profiles and refill history will be included in this study if the patient has filled a CGM prescription during the study window and have Medicare or Medicaid prescription insurance. Patients with private insurance will be excluded from data collection. Data will be collected in a password-protected Microsoft Excel worksheet with information on eligibility criteria, insurance coverage, A1c before and after CGM initiation, and CGM refill data. Data will be analyzed after the collection period has ended via descriptive statistics by comparing the number of patients who received CGM pre and post CMS eligibility change, and the number of patients throughout the entire study window that met pre-existing criteria compared to the number that only qualify for CGM due to the expanded criteria. The secondary outcome of improvement in A1c pre and post CGM initiation will be analyzed by a paired student t-test.

Results: The primary outcome of this study will compare the number of patients actively filling CGM sensors at the FQHC pharmacy before and after expansion of eligibility criteria. The secondary outcome of this study will be the change in A1c value pre and post CGM initiation in patients eligible for CGM before and after CMS expanded its criteria. Data collection will begin in November of 2023 following IRB approval.

Conclusions: The results of this research will demonstrate if the expansion of CGM eligibility criteria by CMS impacted patient access and if this led to a significant change in A1c. If the results demonstrate a positive impact, it could provide support for further eligibility criteria expansion (i.e. to all patients with diabetes).