Once approved, the patient’s initial request is valid for 1 year. After that time, coverage may be renewed for 5 years if the patient continues to require multiple daily injections of insulini or insulin pump therapy as part of intensive insulin therapy and will benefit from continued use of a continuous glucose monitor.

i. Multiple daily injections of insulin is defined as one (or more) injection(s) of basal insulin and three (or more) injections of bolus insulin, with a minimum of at least of four total insulin injections per day.