How to Get a CGM Prescription: Steps and Coverage

Getting a continuous glucose monitor prescribed typically starts with a conversation with your doctor, but the path from that conversation to a working sensor on your arm depends on your diagnosis, your insulin regimen, and the specifics of your insurance plan. For people with type 1 diabetes or insulin-treated type 2 diabetes, the prescription process is usually straightforward. For those managing type 2 diabetes without insulin, or people with prediabetes who want to use a CGM, the landscape is more complicated and still shifting. The steps themselves are not difficult, but knowing where the friction points are can save you weeks of back-and-forth.

Start With Your Primary Care Doctor or Endocrinologist

You do not need to see a specialist to get a CGM prescription. While endocrinologists have long been the main prescribers, primary care physicians are writing CGM prescriptions at a rapidly increasing rate. From 2020 to 2021, monthly CGM prescriptions to new users from primary care grew by 125%, compared with 36% overall growth across all settings.¹ Your regular doctor can prescribe a CGM and often will, especially if you are already managing diabetes with them.

That said, the type of provider you see can shape how the conversation goes. Most people starting CGM through an endocrinologist are on intensive insulin regimens, with about 82% fitting that profile. In primary care, the population is more mixed: roughly half are on intensive insulin, and about 28% are not using insulin at all.¹ If you take multiple daily insulin injections or use an insulin pump, either provider type will likely prescribe a CGM without hesitation. If you manage your diabetes with oral medications alone, you may encounter more resistance depending on the provider and your insurer.

What Your Doctor Needs to Justify the Prescription

Insurance companies generally require clinical documentation showing the CGM is medically necessary. What counts as medical necessity varies by plan, but the clinical case typically rests on a few pillars: your diagnosis, your current treatment regimen, how well your blood sugar is controlled, and whether traditional fingerstick monitoring is insufficient for your needs.

For people on intensive insulin therapy, the justification is well-established. Research consistently shows that CGM use leads to meaningful improvements in glucose control. In people with type 2 diabetes, CGM use compared with traditional blood glucose monitoring was associated with about 15 percentage points more time in the target glucose range, along with reductions in HbA1c, daily insulin dose, and weight.² These kinds of outcomes give your doctor strong material to include in the prior authorization paperwork.

Patients who benefit most from CGM tend to be those who are motivated to act on the data, particularly adults with suboptimal glucose control and those using insulin pumps. Researchers have also noted that appropriate patient selection matters: someone who is willing to wear the sensor consistently and respond to the readings will get far more out of a CGM than someone who finds the technology burdensome.³ Your doctor may ask about your willingness to use the device regularly, and a positive answer helps both clinically and administratively.

Insurance Coverage Varies Widely

This is where the process gets messy. Insurance coverage for CGMs depends on whether you have Medicare, Medicaid, or a commercial plan, and even within those categories, the rules differ by state, plan, and year.

Medicare currently covers CGMs for beneficiaries with diabetes who meet certain criteria, typically requiring insulin use or a documented history of problematic hypoglycemia. The coverage rules have expanded over time, but they still leave out many people with type 2 diabetes who could benefit from CGM. Despite growing evidence supporting CGM use in the broader type 2 diabetes population, including those not on insulin, many public and private insurers maintain eligibility criteria that deny access to millions of people.⁴

Medicaid coverage is even more inconsistent. Because Medicaid is administered state by state, there is no unified national policy for CGM coverage. What qualifies you in one state may not in another, and the documentation requirements can differ substantially. Researchers have called for standardizing these criteria across states to reduce disparities in access.⁵

Commercial insurance plans fall somewhere in between. Many cover CGMs for insulin-using patients, but the specifics of prior authorization, required documentation, and out-of-pocket costs vary from plan to plan. Affordability remains one of the top reasons both primary care physicians and endocrinologists hesitate to recommend CGMs. In surveys, both groups cited cost as a key barrier, and less than half of physicians in either group said they were “most likely” to recommend CGM over traditional fingerstick monitoring, even though they agreed the technology can be transformative.⁶ If your doctor seems reluctant, it may not be clinical skepticism; it may be pragmatic concern about whether you will actually be able to afford the device long-term.

Pharmacy Benefit Versus Durable Medical Equipment

One detail that can make or break your experience is how your plan classifies a CGM: as a pharmacy benefit or as durable medical equipment (DME). This distinction sounds bureaucratic, but it has real consequences for how quickly you get your supplies, how much you pay, and how much paperwork your doctor has to do.

When CGMs are classified as DME, you typically get them through a specialty supplier, which often involves more paperwork, longer wait times, and additional authorization hurdles. When states or insurers shift CGM coverage to the pharmacy benefit, the experience changes dramatically. Vermont’s Medicaid program made this switch, and it improved access while reducing the administrative burden on prescribers.⁷ With a pharmacy benefit, you can pick up your CGM sensors at a retail pharmacy just like any other prescription.

There is tension here between insurers and providers. A large majority of endocrinologists and nearly half of primary care doctors report pressure from health insurers to prescribe CGMs through the pharmacy channel rather than as DME.⁶ In practice, the pharmacy route tends to work in the patient’s favor, so this pressure often aligns with your interests even if it complicates things for your clinic.

When you get your prescription, ask your doctor’s office which channel your plan uses. If you have a choice, the pharmacy benefit is almost always simpler. If your plan routes through DME, expect to work with a third-party supplier and build in extra time for authorization and delivery.

What to Do If You Are Denied

Insurance denials for CGMs are not unusual, especially for people with type 2 diabetes who are not on intensive insulin therapy. A denial is not the end of the road. You have the right to appeal, and appeals succeed more often than people expect.

The appeal process typically involves your doctor submitting additional clinical documentation explaining why a CGM is medically necessary for you specifically. This might include records of frequent hypoglycemic episodes, documentation that fingerstick monitoring has been insufficient, evidence of wide blood sugar swings that standard testing misses, or a history of HbA1c levels that remain elevated despite medication adjustments. Effective documentation and proper coding substantially improve the chances of a successful appeal and reimbursement.⁸

If your first appeal fails, most plans allow at least one more level of appeal, and some states have external review processes. Ask your insurer for the specific appeal deadlines, since missing them can forfeit your right to challenge the decision. Your doctor’s office likely has experience with these appeals and may have template letters or staff who handle them routinely.

Reducing Out-of-Pocket Costs

Even with insurance coverage, the monthly cost of CGM sensors can add up. Depending on your plan, copays for a month of sensors might range from modest to several hundred dollars. A few strategies can help.

Manufacturer discount programs are one of the most common ways people reduce costs. Companies that make CGMs frequently offer savings cards, copay assistance programs, or free trial periods. In studies of CGM adoption among people with insulin-treated type 2 diabetes, manufacturer discounts were specifically identified as a facilitator that helped people start and continue using CGMs.⁹ Check the manufacturer’s website for your specific device before filling the prescription, because these programs change frequently and sometimes require enrollment before your first fill.

Other approaches include asking your pharmacy to run the prescription through a secondary discount card, checking whether a mail-order pharmacy offers a lower price, or asking your doctor whether a different CGM brand is on a preferred tier for your plan. The devices made by different manufacturers are clinically similar enough that switching brands for cost reasons is usually reasonable.

Coverage for People With Type 2 Diabetes Not on Insulin

This is arguably the most frustrating gap in the current coverage landscape. Most insurance policies were written when CGMs were considered tools for insulin-dependent patients, and many have not caught up with the evidence. Research now supports the use of CGMs in people with type 2 diabetes treated with basal insulin only or even with non-insulin therapies.¹⁰ The evidence is strong enough that researchers have explicitly argued current eligibility criteria are unjustified and deny access to a valuable technology.⁴

If you fall into this category, your options include asking your doctor to submit a prior authorization with detailed clinical justification, being prepared to appeal a denial, and looking into manufacturer programs that offer sensors at a reduced cost without insurance. Some people in this situation also find that the over-the-counter CGM route, discussed below, is a simpler path.

Over-the-Counter CGMs Changed the Landscape

In 2024, the first over-the-counter wearable glucose monitors became available for purchase without a prescription. These devices are intended for people with diabetes who do not use insulin, as well as for people without diabetes who want to track their glucose for general health reasons.¹¹ The FDA’s approval of OTC CGMs represents a significant shift, because it removes the prescription requirement entirely for certain products aimed at certain populations.

There are important differences between prescription and OTC CGMs. Prescription devices are FDA-cleared for making treatment decisions like adjusting insulin doses, and they integrate with insulin pumps and automated insulin delivery systems. OTC devices carry different labeling and are not intended for insulin dosing decisions. If you have type 1 diabetes or are on intensive insulin therapy, you still need a prescription CGM. If you have prediabetes, or you manage type 2 diabetes with diet and oral medications, an OTC device may give you the glucose data you want without the insurance hassle.

The cost calculation matters here. Paying out of pocket for an OTC CGM may actually be cheaper than navigating insurance for a prescription device, especially if your plan has a high deductible or does not cover CGMs for your indication. OTC devices typically run around $50 to $100 per month depending on the brand and where you buy them, which is comparable to or less than many prescription copays.

Prediabetes and the Gray Zone

Interest in CGMs among people with prediabetes has surged, partly driven by the availability of OTC devices and partly by a growing understanding that glucose variability matters even before a formal diabetes diagnosis. There is particular interest in using CGM data to guide early lifestyle interventions that might prevent progression from prediabetes to diabetes or even support reversion to normal glucose levels.¹¹

Research on CGM use in non-diabetic and prediabetic populations is still in relatively early stages, though some findings are encouraging. A study of non-diabetic and prediabetic individuals of South Asian descent found that CGM metrics could meaningfully differentiate between the two groups, and that glucose variability measures improved over the monitoring period.¹² Still, this is one small study in one population, and broader evidence is thin. If you have prediabetes and want to try a CGM, an OTC device is the most practical path. Very few insurers cover prescription CGMs for prediabetes, and getting a doctor to prescribe one for this indication alone can be difficult.

Researchers have flagged that the growing use of CGMs outside the traditional diabetic population raises questions that the evidence has not yet answered: what glucose targets make sense for people without diabetes, how to interpret the data without overreacting to normal fluctuations, and whether the behavioral changes people make in response to CGM data actually lead to long-term health improvements.¹³ If you are using a CGM without a diabetes diagnosis, keep this uncertainty in mind: the numbers on the screen are real, but the clinical meaning of small glucose fluctuations in a healthy person is still being worked out.

Using Telehealth to Get a Prescription

The pandemic permanently expanded telehealth access for diabetes care, and CGM prescriptions are one area where virtual visits work particularly well. Because CGMs generate data that patients can share electronically with their providers, a virtual appointment is often sufficient for the initial prescription conversation and for ongoing monitoring. CGM use increased during and after the pandemic in part because the devices fit naturally into remote care workflows.¹⁴

Several telehealth platforms now specialize in CGM prescriptions, some of which can prescribe, process insurance, and ship sensors to your door. If your primary care provider is not familiar with CGMs or is reluctant to prescribe one, a telehealth consultation with a provider who routinely prescribes them may be a faster route. This is especially true if you live in a rural area without easy access to an endocrinologist.

Data Privacy Worth Thinking About

A CGM generates a continuous stream of health data, much of it transmitted to your phone, to cloud servers, and potentially to your healthcare team. Before you start wearing one, it is worth understanding what happens to that data. Privacy and security protections for CGM data are not as robust as many patients assume. Researchers have warned that patients’ ability to control how their CGM information is collected, stored, and used is limited, and that inadequate cybersecurity measures could put physical security at risk as well, particularly for devices that connect to insulin pumps or automated delivery systems.¹⁵

In practical terms, this means reading the privacy policy of your CGM’s companion app, understanding whether your data is shared with third parties, and being intentional about which sharing features you enable. If your CGM connects to an insulin pump or automated dosing system, make sure the firmware on all devices stays updated. The integration between CGMs and insulin pumps is a selling point for prescription devices, but it also expands the surface area for potential security issues. None of this should stop you from using a CGM if you need one. But treating the data as sensitive medical information, and being choosy about where it goes, is a reasonable precaution.

1
PubMed Central. Rates and Correlates of Uptake of Continuous Glucose Monitors Among Adults with Type 2 Diabetes in Primary Care and Endocrinology Settings
2
PubMed Central. Time in range—A new gold standard in type 2 diabetes research?
3
PubMed. Is continuous glucose monitoring (CGM) for everyone? To whom should CGM be prescribed and how?
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PubMed. Continuous Glucose Monitoring (CGM) Is a Tool, Not a Reward: Unjustified Insurance Coverage Criteria Limit Access to CGM
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PubMed Central. Increase Access, Reduce Disparities: Recommendations for Modifying Medicaid CGM Coverage Eligibility Criteria
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The American Journal of Managed Care. Perceptions About CGMs Among Primary Care Physicians and Endocrinologists
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PubMed Central. Pharmacy benefit considerations for continuous glucose monitoring acquisition: Vermont Medicaid experience
8
PubMed. Maximizing reimbursement through correct coding initiatives
9
PubMed Central. Navigating Continuous Glucose Monitoring Adoption: Insights From Hispanic Adults With Insulin-Treated Type 2 Diabetes
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PubMed Central. Coverage for Continuous Glucose Monitoring for Individuals with Type 2 Diabetes Treated with Nonintensive Therapies: An Evidence-Based Approach to Policymaking
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PubMed. Continuous Glucose Monitoring for Prediabetes: Roles, Evidence, and Gaps
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Scientific Reports. Metabolic health tracking using Ultrahuman M1 continuous glucose monitoring platform in non- and pre-diabetic Indians: a multi-armed observational study
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PubMed Central. Use of Continuous Glucose Monitors by People Without Diabetes: An Idea Whose Time Has Come?
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PubMed Central. Virtual visits and the use of continuous glucose monitoring for diabetes care in the era of COVID-19
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PubMed Central. Privacy and Security Issues Surrounding the Protection of Data Generated by Continuous Glucose Monitors