Dexcom's CEO remarks that Continuous Glucose Monitors align well with the objectives of the MAHA; Tandem Diabetes Care gears up for forthcoming product launches.
In a significant move, Medicare has broadened its coverage of Continuous Glucose Monitors (CGMs) for people with Type 2 diabetes. As of mid-2025, FDA-approved CGMs, such as Dexcom G6 and G7, are now covered under Medicare Part B for eligible patients, including those with a history of low blood sugar or who are on any type or amount of insulin [1][5].
While Medicare Advantage plans follow similar rules, coverage specifics can vary by plan [1][2]. On the other hand, detailed information on Pharmacy Benefit Managers (PBM) coverage policies for CGMs in Type 2 diabetes remains less clear, with coverage decisions possibly differing under Medicare Advantage plans [2].
Several industry leaders, including Dexcom, Tandem, and Insulet, are actively working to expand CGM access and coverage. Initiatives include programs like "My CGM Coach," which offers CGM patches and coaching for Medicare beneficiaries with Type 2 diabetes or prediabetes and an A1C above 5.7, aiming to improve patient engagement and coverage utilization [3]. These companies also advocate for broader Medicare coverage criteria changes and collaborate with healthcare providers to facilitate easier CGM prescription and monitoring [4].
Recent developments include Tandem's move to develop an insulin patch pump, with the development of the Sigi patch pump now taking place in San Diego. Tandem also plans to launch Mobi outside of the U.S. with multiple sensor integrations by the year's end [6]. Insulet, on the other hand, received an expanded indication for its Omnipod 5 patch pump last year and has seen its revenue grow by nearly 29% to $569 million in the first quarter [7].
Insulet's new CEO, Ashley McEvoy, a longtime medtech executive, is leading these efforts. The company also estimates that the Type 2 indication expands the total addressable market for its patch pumps in the U.S. to more than 5.5 million people with Type 2 diabetes who take insulin [8]. Insulet's chief product and customer experience officer, Benjamin, expects the company could double or even triple the number of people using its patch pumps [9].
Dexcom, meanwhile, is working to gather evidence from a randomized controlled trial to submit a request to the Centers for Medicare and Medicaid Services for coverage for people with diabetes who don't take insulin [5]. Dexcom's revenue for the first quarter reached $1.04 billion, a 12% increase year over year [10].
In summary, Medicare's expanded coverage of CGMs for Type 2 diabetes patients, coupled with industry initiatives, is set to improve access to these life-changing technologies for millions of people.
| Aspect | Status / Initiative | |--------------------------------|------------------------------------------------------------------------------------------------------------------| | Medicare CGM coverage | Covers FDA-approved CGMs (e.g., Dexcom G6/G7) under Part B with updated broader eligibility (insulin use or hypoglycemia history)[1][5] | | Medicare Advantage | Similar CGM coverage but plan-dependent; insurer decides CGM brand coverage[2] | | PBM coverage | No specific detailed data available; likely varies by insurer and plan[2] | | Company efforts | Programs like My CGM Coach (for Medicare patients with Type 2 diabetes/prediabetes), advocacy for wider access, healthcare provider collaboration[3][4] | | Company Developments | Tandem's Sigi patch pump development in San Diego, Mobi launch with multiple sensor integrations, Insulet's Omnipod 5 expansion, revenue growth, new CEO [6][7][8][9] | | Dexcom Initiatives | Gathering evidence for Medicare coverage for people with diabetes who don't take insulin, revenue growth [5][10] |
[1] Medicare Coverage of Continuous Glucose Monitoring Systems (CGMs) [2] Coverage Policies for Continuous Glucose Monitors (CGMs) in Type 2 Diabetes: A Comprehensive Analysis [3] Insulet's My CGM Coach Program Expands Access to CGMs for Medicare Beneficiaries [4] Dexcom Advocates for Broader Medicare Coverage Criteria for CGMs [5] Dexcom's Quest for Medicare Coverage for People with Diabetes Who Don't Take Insulin [6] Tandem's Sigi Patch Pump Development Moves to San Diego [7] Insulet's Omnipod 5 Patch Pump Receives Expanded FDA Indication [8] Insulet Estimates Type 2 Indication Expands Total Addressable Market for Patch Pumps [9] Insulet's Benjamin Expects to Double or Triple Patch Pump Usage [10] Dexcom Reports First Quarter 2023 Revenue of $1.04 Billion
- The expansion of Medicare's coverage of FDA-approved Continuous Glucose Monitors (CGMs) is anticipated to increase access to these life-changing devices for millions of patients with Type 2 diabetes.
- In the healthcare industry, medtech companies like Dexcom, Tandem, and Insulet are actively researching and developing new devices to expand CGM access and coverage.
- Analytics from these devices can provide valuable insights for patient healthcare management and scientific research in the health-and-wellness and nutrition sectors.
- Investors following the medtech and business sectors are closely watching the earnings reports of companies like Dexcom and Insulet, as increased CGM usage and broader coverage could lead to significant financial growth.
- The Food and Drug Administration (FDA) plays a crucial role in the approval process of these devices, ensuring their safety and efficiency for patient use.
- News about the latest advancements in these devices, such as Tandem's Sigi patch pump development and Insulet's Omnipod 5 expansion, are making headlines in technology and healthcare news.
- As business strategies shift, these companies are collaborating with healthcare providers to facilitate easier prescription and monitoring of these devices for eligible patients.
- The ongoing research, innovation, and advocacy in the medtech industry aim to improve patient outcomes, drive advancements in science, and facilitate broader access to health-and-wellness technologies.
