Change in coverage for continuous glucose monitors for some fully insured groups

Effective January 1, 2022, continuous glucose monitors (CGMs) will no longer be covered under the medical benefit as durable medical equipment for certain Empire BlueCross BlueShield (“Empire”) fully insured groups. For these members, CGMs will only be covered under their pharmacy benefit. This applies for both new prescriptions and refills.

 

We will notify affected members via mail. Members who need to transfer CGMs from their medical benefit to their pharmacy benefit will need a new prescription from their provider.

 

Note that some Empire groups will retain their medical DME coverage for CGMs and these members will have the option of using either the medical or pharmacy benefit. Generally, members receive their CGMs faster when obtained using their pharmacy benefit, so we encourage the use of the pharmacy benefit.

 

If you have questions, please contact Provider Services.

 

1411-1121-PN-NY