Date: July 25, 2022
To: Enrolled Pharmacies
Re: Confirmation of Coverage for Continuous Glucose Monitors per Public Act 102-1093
This notice confirms the Department of Healthcare and Family Services' (HFS) coverage for continuous glucose monitors (CGMs) as required under Public Act 102-1093. Coverage is provided under both Medicaid fee-for-service (FFS) and the HealthChoice Illinois (HCI) managed care plans (MCOs).
The Act requires medically necessary CGMs be provided for individuals diagnosed with type 1 or type 2 diabetes who require insulin for the management of their diabetes. HFS already provides coverage for medically necessary CGMs and insulin, and no program coverage changes are necessary. The criteria for CGM coverage can be found at Criteria and Forms | HFS (illinois.gov) under the Criteria heading.
Questions regarding the FFS program may be directed to a pharmacy billing consultant in the Bureau of Professional and Ancillary Services at 877-782-5565. Questions regarding coverage under an HCI MCO should be directed to the applicable managed care plan.
Kelly Cunningham, Administrator
Division of Medical Programs