Continuous Glucose Monitoring for People Living with Type 2 Diabetes Including Those Not on Insulin: A Budget Impact Analysis from a Medicaid Perspective

Background: Key drivers of type 2 diabetes (T2D) health care costs include acute diabetes events (ADEs) and long-term complications. Continuous glucose monitoring (CGM) could lead to cost savings by improving glucose management and reducing the incidence of ADEs and complications. However, coverage of CGM by the US Medicaid system is currently heterogeneous. Aim: To explore the budget impact of increasing CGM reimbursement to all people living with T2D who are beneficiaries of Medicaid. Methods: Budget impact analysis modeling an increase in CGM use of 1% per year for people on multiple daily injections of insulin (MDI) and 2% per year for those on basal insulin or non-insulin therapies. The effect of CGM was modeled as reductions in the costs associated with all-cause hospitalizations (ACH) and all-cause emergency room visits (ACER), based on US data. Results: The annual acquisition cost of CGM was calculated to be $1921, which is partly offset by reductions in test strip and lancet use. After applying reductions in ACH and ACER, the annual net budget impact of CGM for an individual with T2D was estimated to be −$13,034, −$2066, and −$917 for MDI, basal insulin, and non-insulin therapy, respectively. The overall impact on the national Medicaid budget would be net savings of $357 million in year 1, $719 million in year 2, and $1.088 billion in year 3. Conclusions: Increasing CGM use by Medicaid beneficiaries with T2D, including those on non-insulin therapy, resulted in cost savings from the perspective of the US Medicaid system.