About the Report
The clinical and financial burdens placed on the healthcare system by growth in chronic diseases has spurred the search for new care models that generate greater healthcare value, such as those leveraging digital medicine products. Initial studies have shown that improved access to and optimal use of diabetes digital medicine products — for example, continuous glucose monitors (CGMs) and connected insulin delivery devices — can have positive clinical, psychosocial, and economic impacts on people with diabetes and the healthcare system that serves them.
A critical need for digital medicine products has simultaneously grown during the COVID-19 pandemic, as patients receive healthcare services at home. The importance of these products is highlighted by CMS’s easing of requirements for access to CGMs during this period. However, to obtain and utilize these products stakeholders face several challenges like navigating the current reimbursement landscape. As more digital medicine products become available and enable a new era of care, modernizing the reimbursement paradigm will facilitate their seamless integration into the healthcare system and their optimal use.
This report explores the current coverage and reimbursement paradigm for digital medicine products, which was largely codified before digital devices became prevalent, and examines possible barriers to access and use. Modernizing the reimbursement landscape across the U.S. healthcare system can aid in optimal access to and use of these new, and increasingly used, devices. Challenges exist in the form of coverage differences between insurance types such as commercial and Medicare. Additionally, healthcare providers and other stakeholders face challenges regarding reimbursement for time spent using these products and their expertise advising patients. Specifically, significant time investment is required for healthcare providers (HCPs) to train themselves on how to use these technologies, initiate patient use, and support the ongoing needs of patients that may not be reimbursed.
At its conclusion, the report presents short and long-term solutions that offer opportunities to better integrate digital medicine products into the U.S. healthcare system. Changes in policy to reimburse for HCP time and expertise may help optimize use of diabetes digital medicine products in the longer term. For example, the healthcare system could benefit from the development of new CPT codes to allow for HCPs to be reimbursed for training on the use digital medicine products and for patient coaching and counseling. Modifying current CPT codes to allow for more frequent remote analysis and interpretation of diabetes digitally collected data, modifying coding frequency, and expanding eligibility to the wider clinician team involved in care could similarly encourage adoption.