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March 2024
Starting March 1, we’ll require a prior authorization for some continuous glucose monitor products
What you need to know
- We’re requiring prior authorization for some continuous glucose monitor products beginning March 1, 2024.
- Coverage requirements outlined in this article must be met.
- For members who are new to continuous glucose monitor products, criteria are effective March 1.
- For members who have used continuous glucose monitor products before March 1, criteria are effective May 1, 2024.
- We may deny coverage if providers don’t request prior authorization.
Beginning March 1, 2024, providers will need to submit a prior authorization for the products listed below to continue coverage for Blue Cross and BCN commercial members. Medicare members are excluded from this change.
Continuous glucose monitor products |
Coverage requirement, effective March 1** |
FreeStyle Libre 14 Day Reader |
- Member requires insulin
Or
- Member has a diagnosis of diabetes and history of problematic hypoglycemia with at least one of the following:
- Recurrent (more than one) level 2 hypoglycemia events (glucose < 54 mg/dL) that persist despite multiple (more than one) attempts to adjust medication(s) and/or modify the diabetes treatment plan
- A history of one level 3 hypoglycemia event (glucose < 54 mg/dL) characterized by altered mental and/or physical state requiring third-party assistance for treatment of hypoglycemia
Or
- Member has a diagnosis of diabetes and is currently pregnant and experiencing post-prandial (after mealtime) hyperglycemia
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FreeStyle Libre 14 Day Sensor |
FreeStyle Libre 2 Reader |
FreeStyle Libre 2 Sensor |
FreeStyle Libre 3 Sensor |
FreeStyle Libre Reader |
Dexcom G6 Receiver |
Dexcom G6 Sensor |
Dexcom G6 Transmitter |
Dexcom G7 Receiver |
Dexcom G7 Sensor |
**Coverage requirements for continuous glucose monitor products that are billed as durable medical equipment through the member’s commercial medical benefit are the same as the criteria in the table above.
Action needed
- Talk to your patients about any concerns they may have.
- Request a prior authorization electronically. If the prescription is not authorized in advance, we may not pay for it.
For more information on how to submit an authorization electronically
- Go to ereferrals.bcbsm.com.
- Select Blue Cross for PPO members or BCN for HMO members.
- Click Pharmacy Benefit Drugs on the left.
- Request a prior authorization to show that the criteria in the table above are met.
For a complete list of covered drugs and coverage requirements, go to bcbsm.com/druglists. |
