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Broaden the Medicare statute to provide coverage of glucose testing supplies for those patients afflicted by severe documented hypoglycemia (low blood sugar) without diabetes.

This nationwide petition asks for support on a critical issue of concern to patients with severe hypoglycemia. Currently the Medicare statute, Social Security Act Title XVIII, section 1861(n) defines durable medical equipment (DME) coverage of glucose monitoring devices for patients with diabetes. Coverage of glucose monitoring is absolutely critical for patients with diabetes, allowing individuals to monitor glucose levels to guide decision-making regarding insulin and other medications, improve health, and improve safety and avoidance of severe hypoglycemia (glucose concentrations less than 3.0 mmol/L or 54 mg/dL) which can occur with diabetes medications.

The current Medicare statute does NOT permit coverage for patients with severe hypoglycemia occurring in the absence of diabetes. 

This makes no sense, as hypoglycemia is dangerous and life-threatening, whether due to insulin or other medications for diabetes, or whether the body itself makes too much insulin. As a result of this statute, doctors treating this condition are unable to assist with improving the well-being and safety of their Medicare patients experiencing hypoglycemia outside of diabetes. It is currently impossible to request coverage via an appeal process for individual patients. (Exceptional attempts to do so have so far been denied).

Medicare DME Medical Directors from around the country agree that a change in coverage is important from a medical perspective, and have suggested pursuing a change in the relevant Medicare statute on behalf of patients with severe hypoglycemia.

The signatories of this petition request your assistance in broadening the statute to provide coverage of glucose testing supplies for those patients afflicted by severe documented hypoglycemia (low blood sugar) without diabetes.

While most people are familiar with the fact that hypoglycemia can occur in response to insulin injection or other medications used for treatment of diabetes, it is less well-recognized that hypoglycemia can also occur when the body itself makes too much insulin, particularly in patients who have genetic disorders of insulin production, tumors which make too much insulin, excessive insulin production after stomach or intestinal surgery, or other hormonal or metabolic disorders. In all these conditions and more, severe hypoglycemia is dangerous and life-threatening. Glucose monitoring, particularly continuous glucose monitors with alarms which activate when glucose levels are falling to dangerous levels, can allow patients to detect hypoglycemia before it becomes severe. This is particularly important for ensuring the safety of those patients with frequent hypoglycemia who are no longer able to sense when glucose levels are falling quickly – a condition called hypoglycemia unawareness.

Lack of coverage of glucose testing supplies for patients with severe hypoglycemia does not make sense from either a personal, medical, or economic perspective:
(1) hypoglycemia impairs the safety, well-being, and life of those with this terrible disease,
(2) severe hypoglycemia requires the assistance of others, and may require costly 911 calls, ambulance transport, and emergency room visits, and
(3) uncontrolled hypoglycemia can cause disability, inability to drive or maintain employment, and increase the burden for both the affected individual, their families, and the community at large.

Thus, we are requesting that elected officials and Medicare leadership formally support our advocacy efforts to introduce a bill to revise the Medicare statute to extend coverage of glucose testing equipment to those patients with severe hypoglycemia outside of diabetes. 

Extending coverage of glucose monitoring supplies (both capillary glucose monitoring and continuous glucose monitoring) to patients affected by severe hypoglycemia is essential to improve the health, safety, and well-being of these patients. 

We specifically seek two action items: 

(1) Sign this petition (form above right) addressed to representatives on the House Ways and Means and Health Subcommittees and officials with the Centers for Medicare and Medicaid Services, the federal agency within the United States Department of Health and Human Services that administers the Medicare program, and 

(2) If you are a physician or health care leader, join the list of distinguished health care leaders heading this petition that is shared with the general public supporting this effort. (Email [email protected] to add your name or provide support)

Please note that we provide additional information about hypoglycemia which may be helpful to you or your patients in regards to fully understanding this condition and our request. 

We thank you in advance for your consideration.

Sincerely,

Mary-Elizabeth Patti MD, FACP
Investigator and Adult Endocrinologist
Joslin Diabetes Center
Associate Professor of Medicine
Harvard Medical School

Robert Lustig, MD, MSL
Professor emeritus of Pediatrics,
Division of Endocrinology
University of California, San Francisco

Robert Ruggiero
Founder & President
Hypoglycemia Support Foundation

Wolfram Alderson
CEO
Hypoglycemia Support Foundation