Evernorth expands continuous glucose monitor coverage

Evernorth, a subsidiary of Cigna, is expanding its diabetes program and will add devices and other technological resources to its traditional pharmaceutical approaches, the company said this week. The goal is to help patients better manage their diabetes.

The diabetes care value program will include coverage for continuous glucose monitors under the pharmacy benefit, which Evernorth said will provide important data on a patient’s glucose levels.

CGMs are usually covered as durable medical equipment under the medical benefit, but the company said this often includes a hefty copay.

Evernorth’s diabetes care value program was launched in 2017. In 2020, Cigna rebranded its health services business line as Evernorth.

What’s the impact
In the U.S., more than 37 million people have diabetes, while 96 million have prediabetes. That’s 11% and 38% of the population, respectively. Poorer communities have higher rates of the condition, the American Diabetes Association found.

Patients with diabetes can’t make enough or make proper use of insulin, the hormone that regulates blood glucose. Too much glucose in the blood can harm organs such as the eyes, kidneys and heart. Left uncontrolled, diabetes can lead to heart attack, stroke, kidney failure, neuropathy and the need for amputation.

CGMs are “essential” for creating the ambulatory glucose profile, a standardized snapshot of daily glucose and insulin patterns, according to the American Diabetes Association.

The ADA found that CGM technology has a number of advantages. For instance, it gives more in-depth data on blood glucose levels than traditional blood glucose meters, and can test every few minutes and send data to a monitor wirelessly, rather than requiring a patient to self-test many times a day. It can also help patients target their insulin dose and make better lifestyle choices, the ADA said.

Data showed patients using CGMs have fewer instances of hypoglycemia and lower average blood glucose levels.

Most insulin users don’t use CGMs, whether due to lack of access, provider awareness, affordability, or some combination of these reasons, said Evernorth. CGMs can be hard to afford because they often fall under the durable medical equipment benefit.

The larger trend
Combating diabetes has become an area of increasing focus for healthcare providers– Geisinger has taken on diabetes reversal through grants, philanthropy and executive buy-in by piloting Fresh Food Farmacy in locations with a population of Type 2 diabetes patients.

Type 2 diabetes reversal has also been the focus of a Banner|Aetna partnership with Virta Health on a Type 2 diabetes reversal program. The collaboration gives Banner|Aetna’s fully insured and employer group members access to the virtual, provider-led diabetes program.

CareFirst BlueCross BlueShield recently awarded $1.76 million to grantees addressing diabetes epidemic, with the funding aimed at organizations working to address the upstream social determinants of health impacting the likelihood of developing diabetes. Healthcare Finance News