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Re: [IP] Anthem Blue Cross/Blue Shield of CA - Now Covering CGM

On April 16, 2008, my BC of California policy was amended to read:

 "Long-term use of continuous interstitial glucose monitoring devices as an
adjunct to standard care is considered medically necessary in the care of the

 Patients with Type 1 diabetes who have experienced recurrent episodes of severe
hypoglycemia with blood glucose less than 50mg/dL; or
 Patients with Type 1 diabetes who are pregnant, during the course of the
When all of the following criteria are met:

 Inadequate glycemic control despite compliance with frequent self-monitoring
(at least four times per day) and including fasting hyperglycemia (>150 mg/dl)
or recurring episodes of severe hypoglycemia (<50 mg/dl). This poor control is
in spite of compliance with multiple alterations in self-monitoring and insulin
administration regimens to optimize care; and
 Insulin injections are required 3 or more times per day or an insulin pump is
used for maintenance of blood sugar control; and
Four or more fingersticks are required per day.

Investigational and Not Medically Necessary:
 Use of continuous interstitial glucose monitoring devices and related supplies
are considered investigational and not medically necessary for any indications
not meeting the above criteria.

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