{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T19:05:52Z","timestamp":1784574352154,"version":"3.55.0"},"reference-count":28,"publisher":"American Diabetes Association","issue":"8","license":[{"start":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:00:00Z","timestamp":1781740800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.diabetesjournals.org\/journals\/pages\/license"}],"funder":[{"DOI":"10.13039\/100007028","name":"Leona M. and Harry B. Helmsley Charitable Trust","doi-asserted-by":"publisher","award":["2304-05962"],"award-info":[{"award-number":["2304-05962"]}],"id":[{"id":"10.13039\/100007028","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Because of a computer-based prior authorization (PA) centralized system failure, Medi-Cal authorities temporarily suspended PA requirements for continuous glucose monitoring (CGM) and insulin pumps, including automated insulin delivery systems, for 18 months. We assessed whether this PA-free period improved access to diabetes technology or impacted glycemic control.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                    <jats:p>We conducted a retrospective chart review of 105 adults with type 1 diabetes in a safety net clinic across two sequential policy periods: PA-required and PA-free. Observational outcomes included device prescriptions, delays, denials, device receipt, and HbA1c. Paired t tests (\u03b1 = 0.05) assessed HbA1c changes; descriptive statistics summarized access. Definitions for delay and access outcomes were standardized a priori.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>During the PA-required period, 32 CGM prescriptions were written; 46% were delayed (mean: 82 days), and 21% were denied. During the PA-free period, 27 new CGM prescriptions were written; approvals increased, and mean delay decreased to 40 days, although delays persisted. CGM use increased from 36.2% to 81.0%, and pump use increased from 16 to 25 patients. Mean HbA1c decreased from 9.1%, 76 mmol\/mol (SD = 2.16), to 8.5%, 69 mmol\/mol (SD = 1.89) (P = 0.032).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Removal of PA requirements was associated with improved access to diabetes technology and clinically meaningful HbA1c reductions. Residual barriers highlight persistent structural inequities. Findings support policies that reduce administrative burden for clinically indicated populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2337\/dc26-0284","type":"journal-article","created":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T13:19:09Z","timestamp":1781788749000},"page":"1467-1473","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Prior Authorization Suspension on Access to Diabetes Technology in an Underserved Population: A Retrospective Analysis"],"prefix":"10.2337","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0243-2192","authenticated-orcid":false,"given":"Valerie","family":"Ruelas","sequence":"first","affiliation":[{"name":"Division of Endocrinology, Department of Medicine, Keck School of Medicine of USC, University of Southern California 1 , Los Angeles, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mallory","family":"Bernstein","sequence":"additional","affiliation":[{"name":"Division of Hematology and Oncology, University of California Irvine 2 , Irvine, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3241-5601","authenticated-orcid":false,"given":"Jaquelin","family":"Flores Garcia","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Children\u2019s Hospital Los Angeles 3 , Los Angeles, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn","family":"Topalis","sequence":"additional","affiliation":[{"name":"Los Angeles County Department of Health Services 4 , Los Angeles, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne L.","family":"Peters","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Medicine, Keck School of Medicine of USC, University of Southern California 1 , Los Angeles, CA"},{"name":"Leonard D. Schaeffer Institute for Public Policy and Government Service, University of Southern California 5 , Los Angeles, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2026,6,18]]},"reference":[{"key":"2026072014521392800_B1","doi-asserted-by":"crossref","first-page":"S146","DOI":"10.2337\/dc25-S007","article-title":"7. Diabetes technology: Standards of Care in Diabetes\u20142025","volume":"48","author":"American Diabetes Association Professional Practice Committee","year":"2025","journal-title":"Diabetes Care"},{"key":"2026072014521392800_B2","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1001\/jama.2016.19975","article-title":"Effect of continuous glucose monitoring on glycemic control in adults with type 1 diabetes using insulin injections: the DIAMOND randomized clinical trial","volume":"317","author":"Beck","year":"2017","journal-title":"JAMA"},{"key":"2026072014521392800_B3","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1089\/dia.2021.0496","article-title":"Solutions to address inequity in diabetes technology use in type 1 diabetes: results from multidisciplinary stakeholder co-creation workshops","volume":"24","author":"Agarwal","year":"2022","journal-title":"Diabetes Technol Ther"},{"key":"2026072014521392800_B4","doi-asserted-by":"crossref","first-page":"3411","DOI":"10.1210\/jc.2013-1589","article-title":"Severe hypoglycemia and diabetic ketoacidosis in adults with type 1 diabetes: results from the T1D Exchange clinic registry","volume":"98","author":"Weinstock","year":"2013","journal-title":"J Clin Endocrinol Metab"},{"key":"2026072014521392800_B5","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1089\/dia.2013.0072","article-title":"Continuous glucose monitoring pilot in low-income type 1 diabetes patients","volume":"15","author":"Sequeira","year":"2013","journal-title":"Diabetes Technol Ther"},{"key":"2026072014521392800_B6","unstructured":"Committee on Community-Based Solutions to Promote Health Equity in the United States\n          . The need to promote health equity, 2017. Accessed 12 January 2026. Available from https:\/\/www.nationalacademies.org\/read\/24624\/chapter\/1"},{"key":"2026072014521392800_B7","unstructured":"American Medical Association.\n          \n          Prior authorization, 2025. Accessed 31 December 2025. Available from https:\/\/www.ama-assn.org\/practice-management\/prior-authorization\/prior-authorization"},{"key":"2026072014521392800_B8","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1177\/19322968221144052","article-title":"Increase access, reduce disparities: recommendations for modifying Medicaid CGM coverage eligibility criteria","volume":"18","author":"Galindo","year":"2024","journal-title":"J Diabetes Sci Technol"},{"key":"2026072014521392800_B9","first-page":"qxae096","article-title":"Perceptions of prior authorization burden and solutions","volume":"2","author":"Sahni","year":"2024","journal-title":"Health Aff Sch"},{"key":"2026072014521392800_B10","unstructured":"Committee on Community-Based Solutions to Promote Health Equity in the United States, Board on Population Health and Public Health Practice, Health and Medicine Division, National Academies of Sciences, Engineering, and Medicine\n          . Communities in action: pathways to health equity,2017. Accessed 31 December 2025. Available from https:\/\/www.nationalacademies.org\/publications\/24624"},{"key":"2026072014521392800_B11","unstructured":"American Medical Association.\n          \n          Prior authorization, 2026. Accessed 12 January 2026. Available from https:\/\/www.ama-assn.org\/practice-management\/prior-authorization\/prior-authorization"},{"key":"2026072014521392800_B12","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1001\/jamaneurol.2023.4324","article-title":"Streamlining prior authorization to improve care","volume":"81","author":"Busis","year":"2024","journal-title":"JAMA Neurol"},{"key":"2026072014521392800_B13","unstructured":"Department of Healthcare Services\n          . Medi-Cal overview,2026. Accessed 9 January 2026. Available from https:\/\/www.dhcs.ca.gov\/services\/medi-cal\/Pages\/default.aspx"},{"key":"2026072014521392800_B14","unstructured":"Marin Health and Human Services\n          . What is the difference between full scope and restricted scope benefits?, 2025. Accessed 31 December 2025. Available from https:\/\/www.marinhhs.org\/faq\/what-difference-between-full-scope-restricted-scope-benefits"},{"key":"2026072014521392800_B15","unstructured":"Social Security Administration\n          . Medicare, 2025. Accessed 31 December 2025. Available from https:\/\/www.ssa.gov\/pubs\/EN-05-10043.pdf"},{"key":"2026072014521392800_B16","unstructured":"Personal Assistance Services Council\n          . Health benefits, 2025. Accessed 31 December 2025. Available from https:\/\/pascla.org\/pasc-health-benefits\/"},{"key":"2026072014521392800_B17","unstructured":"Health Services Los Angeles County\n          . Get coverage & help paying your bill \u2013 Patient Financial Services (PFS),2025. Accessed 9 January 2026. Available from https:\/\/dhs.lacounty.gov\/patient-information\/get-coverage\/financial-services\/"},{"key":"2026072014521392800_B18","doi-asserted-by":"crossref","first-page":"103208","DOI":"10.1016\/j.jbi.2019.103208","article-title":"The REDCap Consortium: building an international community of software platform partners","volume":"95","author":"Harris","year":"2019","journal-title":"J Biomed Inform"},{"key":"2026072014521392800_B19","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)\u2013a metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","author":"Harris","year":"2009","journal-title":"J Biomed Inform"},{"key":"2026072014521392800_B20","doi-asserted-by":"crossref","first-page":"w533","DOI":"10.1377\/hlthaff.28.4.w533","article-title":"What does it cost physician practices to interact with health insurance plans?","volume":"28","author":"Casalino","year":"2009","journal-title":"Health Aff (Millwood)"},{"key":"2026072014521392800_B21","doi-asserted-by":"crossref","first-page":"1735","DOI":"10.1001\/jama.2014.13841","article-title":"The Affordable Care Act and health insurance for Latinos","volume":"312","author":"Doty","year":"2014","journal-title":"JAMA"},{"key":"2026072014521392800_B22","doi-asserted-by":"crossref","first-page":"736","DOI":"10.2337\/dc17-0133","article-title":"The impact of continuous glucose monitoring on markers of quality of life in adults with type 1 diabetes: further findings from the DIAMOND randomized clinical trial","volume":"40","author":"Polonsky","year":"2017","journal-title":"Diabetes Care"},{"key":"2026072014521392800_B23","unstructured":"National Institute of Diabetes and Digestive and Kidney Diseases.\n          \n          What\u2019s new in the 2024 ADA Standards of Care?, 2024. Accessed 12 January 2026. Available from https:\/\/www.niddk.nih.gov\/health-information\/professionals\/diabetes-discoveries-practice\/ada-2024-standards-of-care"},{"key":"2026072014521392800_B24","doi-asserted-by":"crossref","first-page":"e2445316","DOI":"10.1001\/jamanetworkopen.2024.45316","article-title":"Disparities in continuous glucose monitoring among patients receiving care in federally qualified health centers","volume":"7","author":"Wallia","year":"2024","journal-title":"JAMA Netw Open"},{"key":"2026072014521392800_B25","doi-asserted-by":"crossref","first-page":"e2549093","DOI":"10.1001\/jamanetworkopen.2025.49093","article-title":"Integrating prior authorization into clinical workflows for care access and practitioner experience","volume":"8","author":"Chen","year":"2025","journal-title":"JAMA Netw Open"},{"key":"2026072014521392800_B26","article-title":"Diabetic supplies update: changes to continuous glucose monitoring systems policy","volume":"1","author":"Tereschenko","year":"2023","journal-title":"Effective"},{"key":"2026072014521392800_B27","unstructured":"Center for Health Care Strategies\n          . Continuous glucose monitor access for Medicaid beneficiaries living with diabetes: state-by-state coverage, 2023. Accessed 12 January 2026. Available from https:\/\/www.chcs.org\/resource-center-item\/update-on-continuous-glucose-monitor-access-for-medicaid-beneficiaries-living-with-diabetes\/"},{"key":"2026072014521392800_B28","doi-asserted-by":"crossref","first-page":"3114","DOI":"10.1097\/CCM.0b013e3181bc7bd5","article-title":"Why we should be wary of single-center trials","volume":"37","author":"Bellomo","year":"2009","journal-title":"Crit Care Med"}],"container-title":["Diabetes Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/49\/8\/1467\/887464\/dc260284.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/49\/8\/1467\/887464\/dc260284.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T18:52:20Z","timestamp":1784573540000},"score":1,"resource":{"primary":{"URL":"https:\/\/diabetesjournals.org\/care\/article\/49\/8\/1467\/172105\/Impact-of-Prior-Authorization-Suspension-on-Access"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,18]]},"references-count":28,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,6,18]]},"published-print":{"date-parts":[[2026,8,1]]}},"URL":"https:\/\/doi.org\/10.2337\/dc26-0284","relation":{},"ISSN":["0149-5992","1935-5548"],"issn-type":[{"value":"0149-5992","type":"print"},{"value":"1935-5548","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,18]]}}}