A leading Durable Medical Equipment (DME) manufacturer providing continuous glucose monitoring (CGM) systems to patients with diabetes since 1999. Based in San Diego, the client employs approximately 2,500 people and currently serves over 200,000 patients around the world. Their products allow individuals to manage their blood sugar in real time and eliminate the need for regular finger pricks.

Our client’s products qualified for Medicare coverage for the first time in 2016, following grassroots advocacy efforts and significant Congressional pressure. They are currently the only CGM system approved for payment by Medicare, and the only system that allows patients to make diabetes treatment decisions without fingerstick data. The manufacturer initially hired Applied Policy for its expertise in obtaining a revised HCPCS code for one of its products, but the relationship has significantly expanded.

Applied Policy assisted the client in understanding and influencing the Centers for Medicare & Medicaid Services (CMS) reimbursement policies for CGM. Applied Policy helped the client build relationships with the DME Medicare Administrative Contractors, the Office of Management & Budget, and CMS policymakers in order to develop coverage and payment policies that benefited Medicare beneficiaries and the client. With assistance from Applied Policy’s decades of experience in both government payers and industry, all parties coordinated on issues of adequate coverage criteria, billing and coding, and compliance. As a result of Applied Policy’s work, the client can successfully serve approximately 300,000 new Medicare beneficiaries and continue to lead both the private and public marketplace in improving the lives of patients with diabetes.