Panel backs bill to publish continuous glucose monitor coverage rules, align pharmacy and DME policies
Summary
The Senate Health and Human Services Committee gave SB 1132 a due-pass recommendation to require clear, published coverage criteria and parity between pharmacy and durable medical equipment benefits for continuous glucose monitors.
The Senate Health and Human Services Committee gave a due-pass recommendation to SB 1132, a bill that would require contractors to provide members with continuous glucose monitors (CGMs) under either a pharmacy or durable medical equipment benefit, align coverage criteria between the two benefit types and post an easily accessible, standalone coverage document.
Diane McAllister of Dexcom told the committee her company and a coalition of stakeholders sought clarity and transparency about CGM coverage and prior-authorization rules. “The bill doesn’t actually change what the coverage policy for CGMs is at the agency,” McAllister said. “We’re not trying to change any of that. However, it would make it clear for patients and doctors what the benefits are and what the requirements to get a CGM are.”
Proponents said inconsistent placement of CGM coverage — sometimes under a pharmacy benefit and sometimes under a durable medical equipment (DME) benefit — created confusion and delays. Julie Hoffman, chair of advocacy for the American Diabetes Association’s Arizona leadership council (testifying in a personal capacity), recounted a case in which a child’s CGM took more than two months to reach the family because paperwork moved between DME suppliers and insurers.
The bill would also require plans to align coverage criteria to current standards of care, which testimony identified as American Diabetes Association guidance. McAllister said the bill does not require the agency to change how it sets clinical standards; it directs publication of the coverage criteria and parity between benefit types so clinicians and patients can find and follow the rules.
Committee action: the vice chair moved SB 1132 with a due-pass recommendation; the committee recorded a vote of 6 ayes, 0 noes and 1 not voting and issued the recommendation.
Why it matters: supporters framed the measure as a transparency and access fix aimed at preventing delays that can cause clinical harms and unnecessary hospitalizations. The bill does not mandate coverage of a specific manufacturer or product; testimony noted differences among devices (for example, sharing capabilities vary by product). The committee adopted no amendments during the hearing.
Ending: SB 1132 advanced from the committee with a due-pass recommendation and will proceed through the legislative process.
