Analysts have suggested that companies like Abbott (NYSE:ABT) and Dexcom (Nasdaq:DXCM) may benefit from expected reimbursement progress.
BTIG hosted a conference call with North Shore Medical Center (Salem, Massachusetts) Medical Director Dr. Gary Cohen and Healthcare Analytics, LLC analyst and consultant Dr. Joshua Cohen. The two experts offered insights into prescriber and patient interest in continuous glucose monitors (CGMs) among type 2 diabetes non-intensive insulin therapy (T2 NIIT) patients.
Analysts Marie Thibault and Sam Eiber wrote in a report that they “came away more encouraged that the growing clinical and economic evidence and shifting society guidelines may translate into greater payor coverage in the next couple of years,” meaning we could see increased CGM adoption in this patient population for both Abbott and Dexcom. As such, BTIG lists both companies as “buy” options.
The report said that CGM coverage among public and private payors has expanded over recent years. In December 2021, the U.S. Centers for Medicare & Medicaid Services (CMS) announced expanded coverage for CGMs, ranging across all types of CGMs, including adjunctive and non-adjunctive CGMs, with CMS removing its requirement for four daily fingersticks to qualify for a CGM as well.
Dr. Gary Cohen said the trend over recent years has made insurance coverage for a CGM in basal-only patients more attainable. There have been successes in getting CGMs covered by Blue Cross Blue Shield of Massachusetts, AllWays for Mass General Brigham employees, Point32Health, and some Medicare Advantage plans. While Medicare coverage and other commercial payors have been varied, he reported that Medicaid remains challenging.
According to BTIG, Dr. Joshua Cohen feels the next steps for CMS include expanding coverage to basal-only and non-intensive patients, with recent changes to The American Diabetes Association (ADA) 2022 Standards of Care stretching its CGM recommendation to people on basal-only insulin.
The analysts said ongoing investments by Abbott and Dexcom on direct-to-consumer marketing and a salesforce targeting and educating primary care physicians (PCPs) may increase awareness and interest among both patients and providers.
“We think the most important factors for greater adoption are reimbursement and PCP education,” Thibault and Eiber wrote. “Dr. Cohen noted all of his motivated patients with diabetes would use a CGM if made available and that using a CGM does change their behavior. But, though his PCP peers are aware of CGMs, he believes it will take time for prescribing trends to change, as many PCPs do not prioritize learning about new technology.”