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March 2025
How to obtain CGM products for commercial, Medicare Advantage members
As we announced in August and December 2024, the methods for obtaining continuous glucose monitor, or CGM, products have changed, as explained in the table below.
Situation |
Method for obtaining CGM products |
Commercial member with both medical and pharmacy benefits through Blue Cross Blue Shield of Michigan or Blue Care Network |
These members can obtain CGM products through either:
- A durable medical equipment, or DME, provider under medical benefits
- A participating network pharmacy under pharmacy benefits
Members’ out-of-pocket costs for CGM products may vary depending on the benefit under which the CGM product is billed. Some members may have lower out-of-pocket costs under pharmacy benefits compared to medical benefits and vice versa. |
Commercial member with only medical benefits through Blue Cross or BCN |
These members must obtain CGM products through a DME provider under their medical benefits.
Note: These members may have pharmacy benefits through a different payer. |
Medicare Advantage members |
Medicare Plus Blue℠ and BCN Advantage℠ members must obtain CGM products through a participating network pharmacy under their Part B benefits at the point of sale.
Blue Cross and BCN no longer cover CGM products dispensed by a contracted or noncontracted DME provider for Medicare Advantage members.
Exception: UAW Retiree Medical Benefits Trust members are excluded from this change. These members should continue to obtain their CGM products through a DME supplier. |
To help health care providers navigate this change, we’ve published a new document titled Continuous glucose monitors: Frequently asked questions for prescribing providers. It includes:
- Steps to verify whether a commercial member has medical benefits, pharmacy benefits or both through Blue Cross or BCN
- What providers need to do so their patients can obtain CGM products
- Information about where to send orders for CGM products
- The criteria that must be met for CGM products to be payable
- Steps to find DME suppliers and pharmacies that dispense CGM products
- Information about prior authorization exemptions for physicians (M.D.s and D.O.s) who participate in the Michigan Collaborative for Type 2 Diabetes, or MCT2D, or in the Provider-Delivered Care Management, or PDCM, program
- Information for members
There are links to the new FAQ document on the Diabetes Supplies pages and the DME/P&O pages on ereferrals.bcbsm.com.
Here are links to earlier provider alerts about this change:
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