INS-CONTINUOUS GLUCOSE MONITOR
This legislation is likely to significantly impact patients with diabetes by ensuring broader access to essential diabetes management tools. Patients no longer need to demonstrate uncontrolled diabetes or a history of severe episodes to qualify for coverage. Additionally, the bill removes hurdles related to authorization processes which can often delay necessary treatment. Such changes could lead to improved health outcomes for countless individuals who require continuous monitoring of their glucose levels.
House Bill 5382 amends the Illinois Insurance Code to mandate coverage for continuous glucose monitors (CGMs), related supplies, and training for individuals diagnosed with any type of diabetes mellitus, effective for policies amended or renewed on or after January 1, 2025. The bill aims to improve access to CGMs, making it easier for patients to manage their diabetes without the burden of prior authorization requirements. It stipulates that coverage must be provided as long as the conditions for eligibility set out in the bill are met, which include having had a telehealth or in-person visit with a prescriber to confirm diabetes control and treatment needs.
While the bill enjoys support for enhancing healthcare coverage, concerns have been raised regarding the potential implications for insurance costs. Critics argue that mandated coverage could lead to increased premiums for all policyholders, as insurance companies will likely pass on the costs associated with covering CGMs without any cost-sharing mechanisms like copayments or deductibles. Furthermore, the absence of a requirement for intensive insulin therapy as a condition for coverage may lead to debates about managing resources effectively among the insured population.