Point Person: Holly Canupp PharmD CPP,

CGM

Please refer all potential new CGM starts to Holly. Requirements vary by insurance, and this is the best way to ensure that patients qualify and the correct orders are placed.

To refer: 

1. Please enter an “e-communication to DOC Pharmacy-CGM” in the orders for the patient

1. “Include CGMREQUIREMENTS smartphrase” at every visit when DM/CGM are assessed.

How to View CGM Data (Dexcom or Freestyle Libre):

• If a patient uses the reader (not their phone):
  • Ask your nurse to upload it to the computer and give you the report
• If a patient uses their phone, they will be connected to our clinic accounts, and you can log in (see below).
• Look at their phone or reader in the room to see their average glucose and time in range!

Viewing CGM Data Remotely:

Diabetes Testing Supplies

Eligibility

• Medicare: defaults to covering 1 test strip per day for non-insulin dependent diabetics and 3 per day for insulin-dependent diabetes and requires prior authorization for anything more.
  • If you want a frequency that differs from this, just justify it on the form (e.g. Type 1 diabetes, brittle, poor control, new exercise program, etc.).

Initial Order

• In the note, document the need for the supplies, including the diagnosis code, most recent A1c value, and frequency of glucose testing.
• Consider using the SmartSet “Diabetes Discharge” to place an order for the supplies (under Plan >> Smartsets), which typically include:
  • “Blood glucose meter with lancing device”
    • Or “Blood glucose meter kit” and “Lancing device” (esp. for Walmart Relion brand)
  • “Lancets” – 30/m if QD or 100/m if TID
  • “Blood glucose test strips” – 30/m if QD or 100/m if TID
  • “Alcohol swabs” – 30/m if QD or 100/m if TID
• Print any supply orders (glucometer and/or lancing device) for the patient to bring to the pharmacy, as these may not auto-send.
• Residents should be able to sign these orders. 
• Relevant Smartphrases: .LOWCOSTINSULIN, .LOWCOSTGLUCOMETER

Refill/Reauthorization

1. These forms come in various formats depending on the pharmacy or supplies vendor; they all ask for diagnosis code, recent A1c, frequency of glucose testing, and a default check box to allow for any supplies needed (lancets, needles, etc.)
2. Residents should be able to sign these orders.

Medications: especially GLP-1 Agonists

Mechanism of Action: GLP-1 peptides promote weight loss by inhibiting glucagon and stimulating insulin release. Can result in 5-15% decrease in body weight that is sustainable for at least 12 months!

Insurance Coverage: GLP-1 agonists are FDA approved for chronic weight management (in addition to T2DM), however coverage for this indication varies based on insurance type.

A Recommendation from our Pharmacy and Prior Auth Team: We have been prescribing increasing amounts of GLP-1 agonists at the DOC! This is exciting but has also resulted in lots of rejections from insurance companies, increased workload, and high volumes of unpleasant messages from patients towards our pharmacy and prior auth teams when a GLP-1 is not covered by their insurance. If you are prescribing a GLP-1 for weight loss (and the patient doesn’t have T2DM), the following would be helpful:

1. 1. Make sure you are prescribing the correct GLP-1:
      • If they only have obesity: Prescribe Wegovy or Zepbound
      • If they have obesity & T2DM: Prescribe Ozempic or Mounjaro
      • For more info on accurate prescribing, check out Holly’s dot phrase/tip sheet: .GLP1WEIGHTLOSS

4. Let your patient know that the prior auth process takes time and that our team is working on it in the background!