Medicare and Freestyle Libre

Freestyle Libre is useful for patients with type 1 or type 2 diabetes. It is used for the better management of intensive insulin therapy. However, this device costs a lot; hence, you might want to know whether it is covered by Medicare.

Here is a brief discussion about whether Medicare Part A and B cover Freestyle Libre and the criteria needed to be eligible for the coverage.

Is it covered?

Medicare now covers FreeStyle Libre that provides CGM or continuous glucose monitoring system in real-time. Previously, most of these devices were not covered by Medicare plans. However, about three months after the use of no-calibration FreeStyle Libre was approved by the FDA as a safer replacement for fingersticks while dosing insulin, the criteria related to its Medicare coverage were changed.

It was later announced that FreeStyle Libre would be covered by Medicare when it is recommended for the better management of type 1 and type 2 diabetes in patients receiving insulin therapy.

Medicare covers the treatment of type 1 or type 2 diabetes that involves intensive insulin therapy with multiple injections or the use of the pump on a daily basis. The coverage includes two CGM systems: Abbott’s FreeStyle Libre that provides real-time monitoring of blood glucose levels and Dexcom’s G5. The patient would be eligible for the coverage of FreeStyle Libre when the following conditions are fulfilled:

• The patient is diagnosed with type 1 or type 2 diabetes
• Takes insulin with an insulin pump or multiple daily injections
• Has been prescribed an insulin plan, which requires frequent changes in the dosages and frequency of the medication based on readings of CGM.
• Uses a blood glucose monitor and performs at least 4 fingersticks a day

Medicare plan would cover FreeStyle Libre when all of these criteria are fulfilled.

The following components of FreeStyle Libre are eligible for Medicare coverage:

• One handheld reader device of FreeStyle Libre, which should last for at least three years
• Three sensors for continuous glucose monitoring per month each of which is expected to be used for 10 days
• Test strips embedded in the FreeStyle Libre reader meant to be used with the blood glucose meter. These strips can be used during the 12-hour warmup period recommended for the use of FreeStyle Libre and at other times.

Unfortunately, the FreeStyle Libre’s system is not available at all retail pharmacies covered by Medicare. It is made available for the patients by prescription in Byram Healthcare, Mini Pharmacy, Edgepark Medical Supplies, Solara Medical Supplies, Better Living Now, Edwards Health Care Services, and Advanced Diabetes Supply.

The decision of the US Centers for Medicare and Medicaid Services (CMS) to cover FreeStyle Libre on such a short notice is a welcome sign. It is expected to help a huge number of patients with diabetes to monitor their blood sugar levels more efficiently and modify their treatment. This will allow them to control their blood sugar levels more efficiently and reduce the risk of complications.

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