Considerations Before Prescribing a CGM
How to choose a CGM Model
The 2 most common prescribed products are Dexcom G7 and Freestyle Libre 3. Here are some features of the two:
Dexcom G7: 10-day wear-period, glucose updates q5 minutes, more advanced alert options, supports manual calibration.
Freestyle Libre 3: 14-day wear-period, glucose updates q1 minute, no manual calibration, no receiver available, slightly smaller sensor.
Data to gather before prescribing
Name of device needing renewal
Indication for CGM (current use of insulin and/or history of hypoglycemia)
If applicable and easily available: date last sensor(s) dispensed and number of sensors
Get the App: Ask your patient to download the "Freestyle Libre 3" or "Dexcom G7"
How To Prescribe a CGM
If your patient has Medicare
Contact the group "MSH LandauerMedstar" via Epic chat with the name of the product you are prescribing.
The representative will likely ask you to document specific language in the chart and may require additional information. The representative will work on getting prior authorization for the product.
Once this is done, an electronic script will be sent to the attending to sign. The patient will receive their product via UPS or FedEx.
Add product to the medication list as a "patient reported" medication
If your patient has commercial insurance OR Medicaid
Find out if your patient prefers home delivery of their CGM device via UPS or FedEx, in which case use the same exact workflow as Medicare above
If they prefer to use a traditional pharmacy with e-prescribing send the following orders to their preferred pharmacy
For Freestyle Libre: 2 sensors with 11 refills
For Dexcom: 3 sensors with 11 refills
For all new users of CGM who do not have a smart phone: also send 1 receiver which is same model as sensors (note, Freestyle Libre 3 does not have a separate receiver)
Most insurance plans require prior authorization for CGMs. Therefore, if using the traditional pharmacy workflow, please send a staff message to "p IMA MEDICATION PRIO-AUTH REQ" and insert the following dot phrase: ".imapriorauthcgm")
How To Access Your Patient's Data in the CGM Portal
Once your patient is using a CGM, offer them the option of connecting their device to our clinic portal. This will allow us to access their glucose data via the cloud at any time. To do this:
1) Email Cary.Blum@mountsinai.org and Kenneth.Fifer@mountsinai.org and we will add you to the account (please specify Dexcom, Libre, or both)
2) Find the email invitation from the portal website(s) and create an account to login to the appropriate portal. Here are the websites
For Dexcom: https://clarity.dexcom.com/professional/
For Libre: https://www.libreview.com/
3) To get your patient's CGM data into the portal
For Dexcom, the patient can navigate to the website connect.dexcom.com and connect using the clinic code "IMAdiabetes". Or, in the the Dexcom app, in the "connections" tab, select "clarity clinic," and enter the code "IMAdiabetes" there.
For Libre, you can send your patient an invitation to share data with our clinic from the portal website. Just go to "Add Patient", enter their info, and they will receive an email asking them to connect. Alternatively, the patient can connect independently by entering the clinic code "IMAdiabetes" in the Freestyle app under "Settings" , "My Practices"