Medicare AdvantagePrior AuthMedium impact
Non-Preferred Continuous Glucose Monitoring Systems (Revised)
Humana·Endocrinology, Family Medicine, Internal Medicine +1 more·Medicare Advantage
Effective date
Jan 1, 2024
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage now requires prior authorization for non-preferred continuous glucose monitoring systems (CGM) like older Dexcom G4/G5, Guardian, and Eversense devices. Members must have tried and failed or shown intolerance to preferred CGM products (Freestyle Libre and Dexcom CGM products) before non-preferred devices will be covered.
Action Required
Immediately: Billing team must verify prior authorization requirements for all non-preferred CGM devices listed in policy before submitting claims to Humana Medicare Advantage. Providers must document patient trial or intolerance to Freestyle Libre AND Dexcom CGM products before requesting non-preferred alternatives. Update encounter forms to capture this requirement. Claims for non-preferred CGM devices will be denied without proper prior authorization.