Schweizer Co-Sponsors Legislation Expanding Access to Continuous Glucose Monitors

A healthcare access bill for diabetic patients, co-sponsored by State Representative Brandun Schweizer, passed through the House and Senate unanimously this Spring and now heads to the Governor, awaiting his signature.

Senate Bill 3414 amends the Illinois Insurance Code and extends access to diabetes glucose monitors and related supplies to all patients, regardless of diabetes type and allows for any physician, physician assistant, or nurse practitioner to prescribe the monitor, where before monitors were only prescribed if deemed medically necessary.

The new coverage mandate created under this legislation requires insurance companies to provide coverage for continuous glucose monitors for any individual if the following six requirements are met:

  • The individual is diagnosed with diabetes mellitus (encompasses all types of diabetes)
  • The continuous glucose monitor has been prescribed by a physician, physician assistance, or nurse practitioner.
  • The diabetes glucose monitor has been prescribed in accordance with the Federal Drug Administration’s outlined use.
  • The prescribing physician, physician assistant, or nurse practitioner has concluded that the individual or individual’s caretaker has sufficient training in using the continuous glucose monitor.
  • The individual is insulin-dependent or has medically documented hypoglycemia.
  • Within six months prior to the prescription of the continuous glucose monitor, the prescribing physician, physician assistant, or nurse practitioner has evaluated the patient and has determined that the individual has met the above criteria.

Additionally, this legislation prohibits prior authorization for the diabetes glucose monitors prescribed to patients not using Medicaid, and prohibits co-pays, except for certain high deductible plans. For Medicaid patients, this legislation requires the Department of Healthcare and Family Services to adopt the new coverage mandate.

“The legislation allows diabetic patients to access updated medical equipment, regardless of the type of diabetes or insurance they may have,” said Rep. Schweizer. “Extending access to continuous glucose monitors, coupled with capping insulin costs, are proactive ways to begin to make lifesaving healthcare more affordable for Illinois families.”

If enacted, this legislation will go into effect as of July 1, 2024.