Lost in Translation: A Disconnect between the Science and Medicare Coverage Criteria for Continuous Subcutaneous Insulin Infusion

Grazia Aleppo; Christopher G. Parkin; Anders L. Carlson; Rodolfo J. Galindo; Davida F. Kruger; Carol J. Levy; Guillermo E. Umpierrez; Gregory P. Forlenza; Janet B. McGill

doi:10.1089/dia.2021.0196

Lost in Translation: A Disconnect between the Science and Medicare Coverage Criteria for Continuous Subcutaneous Insulin Infusion

Grazia Aleppo, Christopher G. Parkin, Anders L. Carlson, Rodolfo J. Galindo, Davida F. Kruger, Carol J. Levy, Guillermo E. Umpierrez, Gregory P. Forlenza, Janet B. McGill

Icahn School of Medicine at Mount Sinai

Research output: Contribution to journal › Review article › peer-review

6 Scopus citations

Abstract

Numerous studies have demonstrated the clinical value and safety of insulin pump therapy in type 1 diabetes and type 2 diabetes populations. However, the eligibility criteria for insulin pump coverage required by the Centers for Medicare & Medicaid Services (CMS) discount conclusive evidence that supports insulin pump use in diabetes populations that are currently deemed ineligible. This article discusses the limitations and inconsistencies of the insulin pump eligibility criteria relative to current scientific evidence and proposes workable solutions to address this issue and improve the safety and care of all individuals with diabetes.

Original language	English
Pages (from-to)	715-725
Number of pages	11
Journal	Diabetes Technology and Therapeutics
Volume	23
Issue number	10
DOIs	https://doi.org/10.1089/dia.2021.0196
State	Published - 1 Oct 2021

Keywords

AID
CSII
Centers for Medicare & Medicaid Services
HCL
Insurance coverage
LGS
PLGS
Type 1 diabetes
Type 2 diabetes

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10.1089/dia.2021.0196

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title = "Lost in Translation: A Disconnect between the Science and Medicare Coverage Criteria for Continuous Subcutaneous Insulin Infusion",

abstract = "Numerous studies have demonstrated the clinical value and safety of insulin pump therapy in type 1 diabetes and type 2 diabetes populations. However, the eligibility criteria for insulin pump coverage required by the Centers for Medicare & Medicaid Services (CMS) discount conclusive evidence that supports insulin pump use in diabetes populations that are currently deemed ineligible. This article discusses the limitations and inconsistencies of the insulin pump eligibility criteria relative to current scientific evidence and proposes workable solutions to address this issue and improve the safety and care of all individuals with diabetes.",

keywords = "AID, CSII, Centers for Medicare & Medicaid Services, HCL, Insurance coverage, LGS, PLGS, Type 1 diabetes, Type 2 diabetes",

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AU - Galindo, Rodolfo J.

AU - Kruger, Davida F.

AU - Levy, Carol J.

AU - Umpierrez, Guillermo E.

AU - Forlenza, Gregory P.

AU - McGill, Janet B.

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Lost in Translation: A Disconnect between the Science and Medicare Coverage Criteria for Continuous Subcutaneous Insulin Infusion

Abstract

Keywords

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