In order to be eligible for Colorado Medicaid coverage of personal CGM, the following requirements must be met:

• The patient self-monitors glucose at least 3 times daily (e.g. fingerstick blood sugars);
• The patient is treated with 3 or more daily administrations of insulin or administers insulin continuously via pump;
• The patient requires frequent adjustment to the insulin treatment regimen based on glucose results (either finger stick or CGM readings)
• The patient has had or will have education specific to the therapeutic CGM system being requested
• The patient and/or their caregiver can hear and view CGM alerts;
• The patient has been seen for diabetes management in past 6 months and will continue to be seen every 6 months for this purpose;
• The patient meets the CGM manufacturer’s recommendations for age range, monitoring and calibration requirements (if applicable), or has otherwise qualifying circumstances that make therapeutic CGM medically necessary.
• For continuing eligibility, all of the above must be met and Colorado Medicaid requires recertification every 6 months; be sure to schedule diabetes follow up for within 6 months of the last visit.

Chart note example: The following is an example of text that you can add to your chart notes for patients meeting Colorado Medicaid’s eligibility criteria. You can copy/paste, add to your EHR’s macro library (sometimes called smartphrases, dotphrases, or auto-text), and/or modify as needed:

• This patient has a diagnosis of diabetes; self-monitors glucose at least 3 times daily; is treated with 3 or more daily administrations of insulin or continuous insulin infusion via pump; requires frequent adjustment of the insulin treatment regimen based on glucose results; has received or will receive education specific to the CGM system being prescribed; is able themselves or has a caregiver who is able to hear and view CGM alerts and respond accordingly; has been personally seen to evaluate their diabetes treatment within the past 6 months; meets the manufacturer’s recommendations for age range, monitoring and calibration requirements or otherwise has circumstances that make continuous glucose monitoring medically necessary.

• Complete the Byers CGM Order Form (available as a printable form or fillable form), the Acentus Standard Written Order Form (available here), or the ADS (US Med) Order Form
• Email or Fax: chart notes, Order Form, and patient contact information (phone, address) to one of the following DME companies: 

Byers Pharmacy
568 US Highway 36
Byers, CO 80103-9700
Store number: 109676
Phone: 303-822-9371
Fax: 1-833-479-0707
Email: dme@byerspharmacy.com

Acentus
Local Contact:  Kelsey Botkin – Diabetes CGM – Account Manager
Phone:  763-688-1241 or 866-684-2507
Fax:  866-695-2183
Email: kelseyb@acentus365.com

ADS (US Med)
Local Contact: Madison Morton- Colorado
Phone: (720) 551-7672
Fax: 1-760-444-8771
Email: mmorton@usmed.com

CCS Medical
Local Contact: Lori Lefevre
Phone: 720-836-0574
Fax: 888-235-5598
Email: lori.lefevre@ccsmed.com 

• Complete the Libre Certificate of Medical Necessity (or the Byers CGM Order Form, Acentus Standard Written Order or ADS (US Med) Order Form)
• To order a Freestyle Libre if patient has a compatible smartphone: Freestyle Libre 2 or 3 Sensors – change sensor every 14 days, dispense 2 sensors (28-day supply), 11 refills; Freestyle Libre 2 plus – change sensor every 15 days, dispense 2 sensors (30-day supply), 11 refills

• If patient does not have a compatible smartphone then also order: Freestyle Libre 2 or 3 Reader - dispense 1 reader (reader life is approx. 3 years)

• Send the Libre Certificate of Medical Necessity, chart notes, and prescription to one of the following DME companies:

Byers Pharmacy
568 US Highway 36
Byers, CO 80103-9700
Store number: 109676
Phone: 303-822-9371
Fax: 1-833-479-0707
Email: dme@byerspharmacy.com

ADS-United States Medical Supply
Phone: 877-270-6508
Fax: 866-347-8544
Email: abbott@usmed.com
Local Contact:  Madison Morton - CGM/Pump Territory Business Manager
Email:  mmorton@usmed.com
Phone:  720-551-7672
Fax:  305-722-9505

Acentus
Local Contact:  Kelsey Botkin – Diabetes CGM – Account Manager
Phone:  763-688-1241 or 866-684-2507
Fax:  866-695-2183
Email: kelseyb@acentus365.com

CCS Medical
Local Contact: Lori Lefevre
Phone: 720-836-0574
Fax: 888-235-5598
Email: lori.lefevre@ccsmed.com 

If patients have Rocky Mountain Health/Prime then send to:
Byram
Local Contact: Nicholas Bohen- Account Manager
Phone: 801-716-8744
Email: nbohen@byramhealthcare.com

• For Medtronic, visit their healthcare professional website for their most current resources: https://www.medtronic.com/us-en/healthcare-professionals/products/diabetes/continuous-glucose-monitoring-systems.html

• Eversense requires that the transmitter be implanted; it is recommended that you seek preauthorization for the implantation procedure before ordering. To become an Eversense provider and to pursue information on ordering, visit https://www.ascensiadiabetes.com/eversense/become-a-provider/#get-started-form.

Dexcom:

Aaron West - Territory Business Manager
Email: aaron.west@dexcom.com
Can help with most Dexcom items, including Hello Dexcom samples.

Alex Brown - Territory Business Manager
Email: alex.brown@dexcom.com
Can help with most Dexcom items, including Hello Dexcom samples.

Terra Thompson, RN, CDE - Clinical Account Manager
Email: terra.thompson@dexcom.com
Can help with all training and Clarity.

Kevin Stroud - District Business Manager
Email: Kstroud@dexcom.com

Can assist with urgent items.

Abbott Freestyle Libre:

Neil Henson– Diabetes Sales Specialist

Phone: 303-513-4307

Email:neil.henson@abbott.com

• Professional CGM
• Sample of Personal CGM
• Self-pay for Personal CGM, with or without various coupons, copay reduction programs, and/or vouchers
• If they haven’t been seen for diabetes management in the past 6 months, have them seen for this purpose (in-person or via telehealth).
• Membership warehouses with pharmacies, like Costco and Sam’s Club, often offer the lowest prices, are usually open to non-members, and may have additional significant discounts for members.