On January 1, 2020, Anthem implemented a preferred edit on Medicare Part B eligible continuous glucose monitors (CGMs). The preferred CGM is Freestyle Libre.

 

Preferred CGM edits do not apply to the following plans/plan types:

 

  • Employer Group Waiver Plans (EGWP) Medicare Advantage Part D (MAPD) through Anthem
  • Employer Group Waiver Plans (EGWP) Medicare Advantage (MA only) through Anthem
  • Individual Medicare Advantage Plans (MA only) through Anthem

 

Delivery channels

Only members enrolled in a plan using preferred CGM edits will need to obtain their CGM systems from a retail or mail order pharmacy. Members on a plan without preferred CGM edits will be able to obtain their CGM systems through durable medical equipment providers in addition to retail and mail order pharmacies. Please check member and plan benefits to confirm the available delivery channels for accessing CGM products.

 

ABSCARE-0664-20

 



Featured In:
November 2020 Anthem Connecticut Provider News