Continuous Glucose Monitor Coverage Criteria And The Need For Prior Authorization Reform

Prior authorization reform remains a key focus in state legislatures due to concerns that current policies hinder access to necessary care. Analysis of continuous glucose monitor (CGM) coverage reveals wide variability and misalignment with clinical standards, causing access barriers for diabetes patients. While utilization management helps control costs, it often denies medically necessary care. Reforms aim to improve transparency, align criteria with evidence-based care, and ensure expert review of denials, balancing cost control with patient access.