IL SB3414

Expands continuous glucose monitor (CGM) coverage under Illinois insurance policies amended, delivered, issued, or renewed before January 1, 2026 to include any form of diabetes mellitus (not just type 1 and 2) for individuals requiring insulin.

Effective January 1, 2026, requires CGM coverage for all individuals diagnosed with diabetes mellitus who meet six criteria: proper prescription by eligible provider, FDA approval, patient training capability, insulin use or documented problematic hypoglycemia history, and recent provider evaluation.

Eliminates prior authorization requirements for qualifying individuals and ensures continuous coverage once a CGM is prescribed.

Prohibits deductibles, coinsurance, copayments, or other cost-sharing for one-month supplies of CGMs (including one transmitter) for policies amended, delivered, issued, or renewed on or after January 1, 2026, with an exception for high-deductible health plans tied to health savings accounts.

Requires the Department of Human Services to adopt rules implementing CGM coverage for the medical assistance program, specifying that providers need not obtain continuing education, devices need not have alarms or alert capabilities, and beneficiaries need not have emergency room visits or hospitalizations to qualify.