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BILL # SB 1132 |
TITLE: AHCCCS; continuous glucose monitors |
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SPONSOR: Payne |
STATUS: Senate Engrossed |
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PREPARED BY: Maggie Rocker |
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The bill would require AHCCCS to provide continuous glucose monitoring devices (CGMs) as both a pharmacy benefit and a durable medical equipment (DME) benefit, update coverage criteria, and post the updated criteria as an easily accessible document on the agency’s website.
Estimated Impact
We estimate the bill has no fiscal impact to the state, as AHCCCS reports that the bill codifies the agency's current practice with respect to billing for CGM.
Analysis
AHCCCS policy currently permits both DME and pharmacy providers to provide glucose testing products when authorized.
The bill would require AHCCCS to 1) require contractors to provide CGMs as both a pharmacy benefit and DME benefit and allow prescribing providers to determine the appropriate option; 2) update coverage criteria for CGMs to align with current standard of care; and 3) post the updated coverage criteria document as an easily accessible standalone document on the agency’s website.
AHCCCS does not anticipate a fiscal impact as a result of the bill’s provisions, as AHCCCS already provides CGM coverage as both a pharmacy benefit and DME benefit, has adopted coverage criteria exceeding current standards of care, and has a standalone document of the coverage criteria available on its AHCCCS Pharmacy webpage under “Prior Authorization Criteria.”
Local Government Impact
None
3/13/25