Abbott provides this information as a courtesy, it is subject to change and interpretation. The customer is ultimately responsible for determining the appropriate codes, coverage, and payment policies for individual patients. Abbott does not guarantee third party coverage or payment for our products or reimburse customers for claims that are denied by third party payors.

* Participating pharmacies and durable medical equipment (DME) suppliers are subject to change without notice.

Prescription Requirements^1,2:

• The Veteran has Type 1, Type 2, or other unspecified diabetes and requires an intensive insulin regimen (e.g. ≥3 injections/day, or insulin pump) to achieve desired glycemic control (target range) based upon shared decision-making, as recommended by VA/DoD Clinical Practice Guidelines Management of Diabetes Mellitus in Primary Care (2017).
• The Veteran has the knowledge and skill set necessary to successfully utilize CGMS, including an understanding of the need to do SMBG for calibration as recommended by the manufacturer, and to evaluate “high” or “low” blood glucose results or trends based upon readings and/or alarms as recommended by the FDA and the treating healthcare team.
• The Veteran has followed provider recommendations for SBGM and therapy changes. This will assist providers with determining potential adherence with CGMS, which is essential in achieving improved outcomes.
• The Veteran agrees to ongoing medical appointments with the multidisciplinary team at least every 6 months (more frequently as recommended) to assess the adherence and benefit derived from CGMS, which will be documented in the medical record and used for justification for continued use.

1. Data on File. Abbott Diabetes Care. 2. https://www.healthquality.va.gov/guidelines/CD/diabetes/DMCPGPocketcardfinal508.pdf (Accessed July 8, 2022).

Abbott provides this information as a courtesy, it is subject to change and interpretation. The customer is ultimately responsible for determining the appropriate codes, coverage, and payment policies for individual patients. Abbott does not guarantee third party coverage or payment for our products or reimburse customers for claims that are denied by third party payors.

Prescription Requirements¹:

• The patient has a diagnosis of Type 1 diabetes mellitus OR Type 2 diabetes mellitus
• One of the following situations applies:
  • Patient is using basal and prandial insulin injections,
  • OR Patient is using a continuous subcutaneous insulin infusion (i.e., insulin pump)
  • OR Patient has Type 2 diabetes mellitus and is receiving insulin therapy and has a history of severe hypoglycemia episodes requiring medical intervention
• The FreeStyle Libre 2 system is prescribed by an endocrinologist or diabetes specialist
• Documentation from the patient record must be submitted with ALL of the following:
  • Diagnosis
  • Medication history, including use of insulin
  • Completion of a comprehensive diabetes education program for the patient
• Patient agrees to wear CGM as directed
• Patient agrees to share device readings with managing healthcare professional for overall diabetes management
• Patient meets the following age requirements
• The FreeStyle Libre 2 system: Patient is 4 years of age or older

1. Department of Defense Pharmacy and Therapeutics Committee Recommendations from the November 2021 Meeting Information for the Uniform Formulary Beneficiary Advisory Panel.

Abbott provides this information as a courtesy, it is subject to change and interpretation. The customer is ultimately responsible for determining the appropriate codes, coverage, and payment policies for individual patients. Abbott does not guarantee third party coverage or payment for our products or reimburse customers for claims that are denied by third party payors.