Diabetes resupply: Train early, often

Q. What challenges should I expect when managing CGM resupply—and how do I overcome them?  

A. There are several operational, regulatory and clinical challenges to overcome, but understanding and proactively addressing potential challenges at the start of a CGM program is key to its success and sustainability. 

Insurance complexity is a common challenge. CGM products may fall under both pharmacy and medical benefits, which can confuse patients and providers. Pharmacy and DME documentation and eligibility can vary greatly from plan to plan. Staff must be trained to verify benefits, guide physician offices through plan-specific documentation requirements, and clearly explain coverage details and patient financial responsibility.  

Patient compliance can be another challenge. Missed resupply cycles can negatively affect glucose control. Automated reminders, outreach calls and easy reorder tools can help patients from running out of critical supplies. 

Documentation must be airtight. CGMs are regulated prescription devices, and missing progress notes or incomplete physician records—such as proof of a six-month physician visit—can result in denied claims. This is especially problematic when physicians are unaware of the audit standards. 

Audits are becoming more frequent as CGM adoption grows. Providers must be ready to furnish complete records and even clarify policy misinterpretations to auditors. 

Upgrading to a new CGM system can be challenging. Insurance coverage for new receivers often follows longer replacement intervals, making it difficult—or even impossible—to fulfill patient requests prompted by consumer advertising for the latest generation.  

Supply chain issues have occasionally impacted CGM availability. Manufacturer partners continue working to meet international demand and support the rapid adoption of CGM technology.  

These challenges can be effectively addressed—and often prevented—through ongoing staff education, strong operational processes and early involvement of compliance oversight when launching a CGM program. 

Matt Edwards is CEO of GEMCO Medical. Reach him at marketing@gemcorehealth.com.