If you are considering getting a Continuous Glucose Monitor (Dexcom or Freestyle Libre) and asking yourself how to get cgm prescription, you have come to the right place. If you are regularly seeing either a primary care doctor or an endocrinologist for your diabetes, they should be able to provide a prescription. We will cover cgm prescription requirements in this article, which is the best starting point for you to ensure a productive visit with your clinician. Use the information below as a starting point to structure the conversation in the event that there are doctor questions cgm-related. In order to get insurance to cover it, it is important that you can demonstrate cgm medical necessity. 

Before your visit: cgm prescription checklist

In order to ensure coverage the first time, it is important that you are prepared with documentation to back up the continuous glucose monitor prescription:

• Recent A1C and lab results can be helpful
  
• A 1–2 week log of glucose values (meter or prior CGM data), meals, activity, and any symptomatic highs/lows (if you are exploring the hypoglycemic route)
  
• A brief note describing hypoglycemia concerns, nocturnal episodes, or variability that affects daily life
  
• Current medication list (insulin, GLP-1s, oral agents), doses, and any changes
  
• Familiarize yourself with your Insurance details and an understanding of potential cgm prior authorization requirements – as this varies from insurance to insurance
  

What to ask: what questions to ask doctor about cgm

Below are 10 targeted questions you can consider asking your provider that align to common cgm eligibility criteria, documentation needs, and a plan to ensure coverage on the first try.

1) “Based on my history, do I meet cgm eligibility criteria?”

If you are understanding what the medical necessity requirements are for your plan, your clinician should be able to cross reference that with your medical history (diagnosis, insulin use, problematic glycemic variability, or clinically significant hypoglycemia). This topic will help understand the likely medical decision and inform your doctor as to what proper documentation is required in your chart for cgm medical necessity.

2) “What clinical details should be in the note to support cgm medical necessity?”

Doctors often include diagnosis codes, history of high and low blood sugar, A1C trends, and current therapy. Clear documentation improves the odds that cgm prior authorization requirements are satisfied on the first try.

3) “Do my current therapies align with cgm prescription requirements?”

Different plans may look at insulin status, frequency of glucose checks, and low blood sugar hypoglycemia risks. Have your clinician confirm how your regimen (e.g., basal/bolus) supports how to get cgm prescription approved.

4) “If we choose Dexcom, what are the dexcom prescription requirements?”

Dexcom prescription requirements do not vary from other brands in terms of the requirement for medical necessity. The paperwork required will be the same as any other brand as they are all continuous glucose monitors. 

5) “If we choose Libre, what is needed for freestyle libre prescription?”

Similar to above, the required documentation fora freestyle libre prescription will be the same as that required for a Dexcom. Proper training on the device will vary, but medicall necessity to ensure coverage is the same. A continuous glucose monitor prescription is required (and brand should be specified) but not the prescription medical requirements wont vary brand to brand.

6) “Will my plan need a prior auth, and what are the cgm prior authorization requirements?”

Many insurance plans do require a prior authorization detailing the diagnosis, treatment regimen, doctor visits, and sometimes logs.

7) “How should I track data to demonstrate benefit after starting CGM?”

Some insurance companies may ask for follow-up notes (every 6-months) demonstrating how CGM affects a patient’s glycemic control. Agree on a simple tracking routine (time-in-range, hypoglycemia frequency, alarms responded to) so ongoing coverage is easier to maintain.

8) “What supplies will you write into the continuous glucose monitor prescription, and at what quantity?”

Confirm the brand and model, ensure the prescription covers sensors and transmitter (if applicable), reader/app, and the refill period. Clear supply details reduce back-and-forth and prevent delays.

9) “If coverage is denied, what’s our plan to appeal how to get cgm prescription?”

Understand the denial reason from your insurance first, and then ask your clinician to ensure the proper evidence is well documented (updated notes, logs, risk documentation) first. Speak with your clinic as to how the clinic handle denials. Ensuring a proper path forward makes a remediation more likely.

10) “What diabetes prescription questions do you have for me so we cover everything today?”

Invite your clinician’s perspective. This ensures both of you address any gaps. If your doctor questions cgm, try to understand why and work with your doctor finalize a plan that aligns with cgm prescription requirements.

Device-specific clarity: Dexcom vs. Libre

When discussing dexcom prescription requirements vs. freestyle libre prescription, ask about:

• Wear time and replacement schedule
  
• App compatibility and data sharing with your care team
  
• Alarm options and whether they suit your lifestyle
  
• Any plan-specific preferences that affect the continuous glucose monitor prescription
  

Documentation matters

Strong notes tie your lived diabetes experience to cgm medical necessity: hypoglycemia risk (including nocturnal episodes), unpredictable variability, safety concerns (driving, caregiving, work), or persistent A1C issues despite appropriate therapy. This is the backbone of meeting cgm eligibility criteria and navigating cgm prior authorization requirements.

Communication tips: how to convince doctor to prescribe cgm

“Convince” here means communicating clearly and ethically:

• Share concrete examples of missed lows, sleep disturbances, how fluctuating blood sugar levels has impacted you and any work/school disruptions
  
• Bring your logs to show patterns that fingersticks miss, describe any symptoms you have been experiencing
  
• Explain goals: fewer surprises, safer exercise, learning food responses
  
• Ask how CGM will integrate into your care plan and follow-ups
  

This collaborative approach helps your clinician connect your real-world challenges to cgm medical necessity and the formal cgm prescription requirements they must document.

After the visit: close the loop

• Confirm who submits the prior auth and what you may need to send (logs, forms).
  
• Ask when to check back if you don’t hear about approval.
  
• Once approved, verify that your continuous glucose monitor prescription includes the correct model and supplies so refills run smoothly.
  

Quick recap

• Prepare with a cgm prescription checklist and recent data.
  
• If your doctor questions cgm, get an understanding of why and try to problem solve with your doctor and insurance company 
• Ensure adequate documentation to ensure a first time pass of any Cgm prior authorization requirements
  
• Ensure chart notes demonstrate cgm medical necessity and align with cgm eligibility criteria. There is no difference between a dexcom prescription requirements & a freestyle libre prescription.
  
• If denied, you and your clinician should already have a plan for how to get cgm prescription approved on appeal
  

Educational disclaimer: This article is for general information only and is not medical advice. Always discuss diagnosis, treatment decisions, and device selection with your clinician.