What barriers (cost, access, training) limit use of CGM and newer diabetes medications in underserved populations?

1. Cost is the headline barrier — device and drug price plus coverage gaps

High acquisition and maintenance costs for CGM devices and consumables, and the expense of newer agents, make price a primary limiter: reviews of underserved cohorts repeatedly identify “high cost” and “limited insurance coverage” as major obstacles to CGM adoption, and Medicaid and other payers do not always reimburse devices or newer drugs uniformly ^{[1] [8] [3]}. Even in programs with nominal coverage, lengthy prior‑authorization and recurring documentation requirements delay starts and interrupt therapy — a provider survey found 92% reported authorization documentation delays that harm care ^[2].

2. Insurance design and administrative friction create access deserts

Policy and payer rules — from restrictive formularies to utilization criteria and complex authorization paperwork — convert clinical eligibility into de facto denial or delay, particularly in Medicaid and safety‑net settings ^{[8] [3] [2]}. State and health‑plan variation means that where someone lives can dictate access: investigations in England and U.S. data both document postcode‑ and plan‑related inequities in technology distribution despite guideline recommendations that technology access be based on clinical need ^{[9] [10]}.

3. Geography and care delivery capacity leave clinics under‑resourced

Underserved regions and high‑Medicaid clinics often lack the infrastructure to prescribe, educate, fit and follow patients on CGM or complex new regimens; geographic and logistical barriers — transportation, clinic bandwidth, and supply distribution — impair continuity of device use and medication follow‑up ^{[1] [3]}. Transformations in practice can boost prescribing: targeted system redesign in a New York practice quadrupled CGM prescriptions over three years, demonstrating that delivery changes can mitigate structural barriers ^[11].

4. Provider‑level factors and implicit bias shape who gets offered technology or new drugs

Negative provider encounters, assumptions about patients’ “ability to handle technology,” and low referral rates to endocrinology are common obstacles; studies rank provider behavior and attitudes alongside system finance and individual preference as top barriers to technology uptake in underserved groups ^{[12] [2]}. The literature flags implicit bias and provider burden — the extra outreach clinicians anticipate needing to support underserved patients — as deterrents to prescribing newer tools ^[2].

5. Training, education and follow‑up are necessary but scarce

CGM yields benefits only when data are reviewed and translated into care; ADA guidance stresses that education and training should be available and not constitute a barrier, but in practice resource‑constrained clinics lack staff, time, or digital capacity to provide ongoing CGM interpretation, algorithm‑based insulin delivery support, or lifestyle and medication counseling tied to GLP‑1/SGLT2 use ^{[10] [5] [7]}. The absence of accessible dietitians and diabetes educators in underserved areas further undermines effective adoption of medications whose benefits interact with nutrition and behavior ^[13].

6. What solutions the reporting highlights — and the tensions behind them

State Medicaid reforms, contracting MCO performance measures, targeted clinic supports, and data‑driven gap identification are proposed remedies that have started to narrow inequities when enacted, but these interventions confront insurer cost‑control incentives and administrative inertia ^{[3] [11]}. Professional guidance (ADA) and advocacy groups push for broader, need‑based access, yet studies show disparities persist even when financial barriers are reduced, indicating multi‑level social, cultural and logistical barriers remain ^{[8] [1]}.

Conclusion

The technical promise of CGMs and modern pharmacotherapies has outpaced equitable delivery: clinical standards now endorse wider use, but cost and payer policy, clinic capacity and geography, provider behavior and insufficient training and support combine to limit uptake in underserved populations. The literature points to workable interventions — streamlined authorization, targeted funding for clinic education, and system redesign — but also reveals that dismantling these barriers requires coordinated policy, payer and clinical‑workforce changes, not just stronger clinical recommendations ^{[5] [3] [11] [2]}.