954-P: Barriers to Enrollment in a Continuous Glucose Monitoring Pilot Program for Medicaid Patients

Background: CGM usage is associated with lower A1c and decreased diabetes-related hospitalizations and emergency room visits. However, there are still many barriers to accessing CGM, with the most prominent being cost and cumbersome insurance eligibility criteria. We aimed to explore and describe barriers to enrollment in a pilot CGM program for Ohio Medicaid patients.

Methods: Patients seen at a large academic medical center in the past year, a diabetes diagnosis and A1c >8.5% were identified by Medicaid. The pilot CGM program removed the need for the common CGM coverage requirements of prior authorizations, multiple daily injections, and glucose logs. Patients had to use a mobile CGM application to participate. Patients were contacted via phone and agreeable participants saw a diabetes care and education specialist for CGM education and initiation and an ambulatory care pharmacist for follow-up. Baseline characteristics were obtained via chart review and data were analyzed using descriptive analyses.

Results: N=43 were contacted for enrollment (mean age 43.4±10.8 years; 88.4% female; 93.0% African American; mean A1c 10.2±2.0%; 58.1% on multiple daily injections) . In total, n=16 (37.2%) agreed to participate, n=17 (39.5%) were unable to be contacted, n=8 (18.6%) were already actively using CGM and n=2 (4.7%) declined to participate. Older age predicted agreeance to participate (β=0.350, p=.022) . Those who agreed to participate were more likely to see primary care over endocrinology for diabetes care X ² (1, N=43) = .62, p=0.018. At one-month post-program enrollment, only n=2 (4.7%) patients successfully started CGM.

Discussion: Although over one-third of participants agreed to enroll in the CGM pilot, there was low CGM initiation. Removal of cost and insurance coverage requirements alone did not result in high CGM adoption. Patients were difficult to reach via phone and offering CGM initiation and education during primary care appointments may improve CGM access and utilization.