Should Employers Cover Continuous Glucose Monitors in Their Health Benefits Plans?

Continuous glucose monitors (CGMs) have long been a vital tool for individuals with diabetes, providing real-time insights into blood sugar levels for 25 years^[1]. However, these devices are about to become available over-the-counter, without a prescription, expanding their potential use beyond diabetic patients. For employers, this raises a key question: Should CGMs be included in company health benefits plans?

Let’s explore the factors employers should consider when deciding whether to cover these devices.

Cost vs. Value: What’s the Impact on Your Health Plan?

CGMs are relatively inexpensive when purchased over the counter with subscription models, like how mobile phone prices are subsidized by the network. According to Forbes Health, the annual price for a CGM monitor, when covered by health benefits, can easily range from $1,200 to $3,600^[2]. Without coverage, the annual costs can soar to $2,000 to $7,000 per year, according to GoodRx^[3]. While this may seem affordable for some, many employees may find the cost prohibitive—especially those from lower-income backgrounds. Offering coverage for CGMs could make this innovative health technology accessible to more employees.

However, it’s essential to weigh the potential impact on overall plan premiums. Including CGM coverage might initially increase costs, but if these devices help prevent more serious and costly health conditions like Type 2 diabetes, employers could save on long-term healthcare expenses.

The Value for Non-Diabetic Users: Is It Worth It?

While CGMs were originally designed for diabetic patients, there’s growing interest in using them as a wellness tool for non-diabetic individuals. For employees who are health-conscious or at risk for conditions like metabolic syndrome, a CGM can provide valuable insights into how food, exercise, and sleep affect blood sugar levels.

But is more data always a good thing? By focusing too much on their blood sugar numbers, users could be distracted from broader health goals, like maintaining a balanced diet, regular exercise, and stress management. Employers need to consider whether CGM coverage promotes meaningful health improvements for all employees or just a select few.

Addressing Health Equity and Accessibility

Another critical consideration is accessibility. Despite Medicare’s expanded coverage for CGMs^[4], many diabetic patients who don’t use insulin still struggle to get reimbursed for these devices. Over-the-counter CGMs may not be covered by most commercial insurance plans, leaving employees with significant out-of-pocket costs.

Offering CGM coverage could help close this gap, particularly for lower-income employees who statistically face more barriers to accessing diabetes care. However, it’s essential to ensure that the devices offer measurable benefits to the wider workforce before making them a central part of the health benefits plan.

Moreover, the long-term benefit of easy access and coverage for preventive monitoring with CGM devices helps to reduce the risk of noncompliance and nonadherence by patients due to lack of access. In my time in nursing, I came to see that ease of access is hugely important for patients. If support is easy to get, patients are more likely to actively and proactively be involved in their own wellness. Providing coverage for over-the-counter treatments and devices can be a great way to improve engagement while keeping costs down.

Fitting CGMs into the Broader Wellness Strategy

CGMs have the potential to play a role in preventive health by encouraging healthier behaviors such as balanced eating, regular exercise, and better stress management. By monitoring glucose levels, employees could make informed decisions that reduce their risk of developing diseases like diabetes or cardiovascular issues.

However, employers must be cautious not to place too much emphasis on glucose tracking as a standalone tool. A well-rounded wellness strategy that includes support for mental health, fitness, nutrition, and stress reduction will likely lead to more sustainable long-term results for your employees.

Educating Employees on the Technology

CGMs provide a wealth of continuous data, but that data is only useful if employees know how to interpret and act on it. Employers who offer CGM coverage should consider accompanying it with education and support. This can include workshops or digital resources that explain how to use the device effectively, how to understand glucose data, and how to apply that knowledge in the context of broader health goals.

Let’s Monitor the Situation

The decision to include continuous glucose monitors in your company’s health benefits plan is multifaceted. While these devices offer clear benefits to diabetic employees and may promote better preventive health for others, employers need to balance the cost and value, and consider health equity issues  and whether CGM use aligns with a comprehensive wellness strategy.

If you're considering whether CGMs are the right fit for your health benefits plan, we can help you take a deeper look at the numbers. Fill out the contact form at the bottom of the page to connect with us and learn more about how we can tailor your plan to meet your employees' needs.

^[1] https://www.ncbi.nlm.nih.gov/books/NBK279046/

^[2] https://www.forbes.com/health/conditions/diabetes/continuous-glucose-monitor-cost/

^[3] https://www.goodrx.com/conditions/diabetes/continuous-glucose-monitor-cost

^[4] https://www.aafp.org/pubs/fpm/blogs/gettingpaid/entry/medicare-cgm-expansion.html