Do You Need a Prescription for a Continuous Glucose Monitor?

Posted by Prescription Hope - See Editorial Guidelines (Last Updated On: Fri Apr 28 2023)

There are many medications and medical devices that have often been the source of confusion, as to whether or not they can be obtained over the counter or with a prescription only.

One such device is a continuous glucose monitor. This article will give a clear understanding of whether you need a prescription for a continuous glucose monitor or not, and what other conditions should be met.

But first, here’s a quick summary to takeaway, then we’ll get into some of the more detailed information.

Do You Need a Prescription for a Continuous Glucose Monitor? Yes, Continuous glucose monitoring needs a prescription. Doctors consider these three main factors when prescribing CGM to a diabetes patient, does the patient:

  • Have intensive or high insulin therapy sometimes called tight blood sugar control
  • Have frequent hypoglycemia or unawareness
  • Often have high or low blood glucose.

So, now that you have a brief answer, we’ll take a more in-depth look, starting with a bit more detail about the prescription for a continuous glucose monitor.

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Does a CGM Need a Prescription?

Continuous Glucose Monitor

To get this started, let’s provide some background on this device, which will make it easier to understand why the device needs a prescription.

A CGM is a device for diabetes patients that gives continuous glucose readouts. This device takes the glucose readings from interstitial fluid (the thin fluid around cells). This device works by placing a thin filament under the skin that senses the glucose.

The whole process of inserting the sensor will feel like inserting a needle stick. After the sensor measures the glucose levels, it transmits the results to a receiving device through a wireless connection between a transmitter and a receiver.

Using a continuous glucose monitor allows the patient and doctor to have a better understanding of how the patient’s body is responding to certain foods, exercise, and their current dose of insulin. This completely and thoroughly helps a doctor to adjust insulin doses, as well as consider and adjust other aspects of the diabetic patient’s medical condition.

It was only through a doctor’s office or other certified health practice that a patient could get access to continuous glucose monitoring. With the increasing effectiveness of this device and its progress in diabetic patients, many wanted to use this device by themselves.

So, then CGM became available for patients to buy for themselves but only through a doctor’s prescription. Even doctors are required to check for certain eligibility before prescribing a CGM. This eligibility can differ in each state.

To Whom Are CGM Prescribed

In general, CGMs are approved by the FDA to be used for children above two years of age and adults. Doctors look for the following diabetes conditions to prescribe a continuous glucose monitor.

  • The patient must be on intensive or high insulin therapy, sometimes called tight blood sugar control.
  • The patient has frequent hypoglycemia or unawareness.
  • The patient often has high or low blood glucose levels.

These guidelines are general considerations. Below are detailed considerations that doctors take into account for adults and children. Some of these also cover the FDA eligibility requirements stated for prescribing CGMs.

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Eligibility Requirements Considered for Adults

CGMs should not be prescribed for all adults with Type 1 diabetes. Instead, it should be considered for adults who have frequent events of the following.

  • Experienced or has gone through more than one severe hypo (low blood sugar) a year with no obvious cause.
  • Experiencing complete hypo unawareness (unaware of symptoms of low blood sugar).
  • Going through more than 2 hypos a week. It should also be considered if these hypos are occurring with no real symptom and if they are severe enough, to affect one’s day-to-day lifestyle.
  • If one is going through extreme fear of hypos and related thoughts.
  • Blood sugar exceeding 215 mg/dL multiple times throughout the day.

Eligibility Requirements Considered for Children

  • Children who go through frequent and severe hypos.
  • Experiencing hypo unawareness.
  • Children in whom it’s complicated to diagnose or recognize hypo symptoms.
  • Children who are under school age with severe diabetic conditions
  • Children who are involved in a high level of sports activities.
  • Children who have other medical conditions along with diabetes that make diabetes management complex. This includes medical conditions like anorexia and steroid treatments.
  • Children who experience high blood sugar levels despite proper management and insulin adjustment.

Based on these, a doctor will prescribe a CGM for a few days or a longer period. This would help doctors to adjust the diabetes care plan better. So, that brings us to the question of how to get CGM.

How to Get a CGM After Receiving a Prescription

Continuous Glucose Monitor

Firstly, it has to be mentioned that getting a CGM can be very expensive. The starter kit for a system can cost hundreds of dollars, plus you have to pay for sensors on top of that. The cost of a CGM will vary depending on the brand and on your insurance coverage.

In some instances, your doctor may want you to use a CGM for just a brief period to get a better understanding of how your blood sugar reacts to different factors. If this is the case, then you may be able to get a CGM at a discounted cost at the doctor’s clinic.

However, in most cases, a patient with use a CGM for a long period as part of their daily diabetes management. Once you have a prescription for a continuous glucose monitor, your insurance may require prior authorization. Your healthcare provider will provide this to your insurance.

Some CGMs can be provided through your pharmacy. Other CGMs may be labeled as durable medical equipment, so you have to get them through a medical supplier. Your doctor should be able to send the prescription directly to either your pharmacy or medical supplier to get the fulfillment process started.

For more questions about how to get a continuous glucose monitor, talk to your doctor.

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To Finish

We hope this has been useful in answering the question of do you need a prescription for a continuous glucose monitor and how to get one.

If you are having trouble affording your medication, then contact us. Prescription Hope works with pharmaceutical manufacturers to help you receive your medication at a set, affordable cost. Enroll with us to find out if you are eligible to receive your prescription medications for $60.00 a month through Prescription Hope’s medication access service for each medication.