Diabetic Testing Supplies

   Overview

  Preferred Products: Blood Glucose Meters and Strips

  Miscellaneous Supplies 

  Billing

 

Overview

Effective April 1st, 2015, diabetic testing supplies, including meters, test strips, lancing devices, lancets, pen needles, syringes, ketone strips, and control solution will be billed as part of the pharmacy point of sale (POS) system. There will be a grace period from April 1st, 2015 to May 31, 2015 to help transition members. Effective June 1, 2015, DME providers will no longer be able to bill diabetic supplies for SoonerCare members. At that time, all diabetic testing supplies will need to be dispensed from a contracted pharmacy provider.

 

Preferred Products: Blood Glucose Meters and Strips

SoonerCare prefers the following brands of diabetic testing meters and strips. All other blood glucose meters and strips will not be covered.

Approval may be granted for non-preferred products if the preferred meter is not compatible with an insulin pump the member is using.

Preferred Blood Glucose Monitors

Blood glucose monitors are restricted to one meter per member per year.

NDC Description

NDC

Price per Meter

FreeStyle Freedom Lite

99073-0709-14

$15.0000

FreeStyle Insulinx

99073-0711-43

$38.0000

FreeStyle Lite

99073-0708-05

$15.0000

One Touch Ultra 2

53885-0448-01

$15.0000

One Touch Ultra Mini Blue Comet

53885-0911-01

$15.0000

One Touch Ultra Mini Pink Glow

53885-0419-01

$15.0000

One Touch Ultra Mini Silver Moon

53885-0208-01

$15.0000
One Touch Verio IQ System
53885-0267-01  $23.0000 
One Touch Verio System 53885-0657-01  $15.0000 
One Touch Verio Flex System  53885-0194-01  $15.0000 

Precision Xtra

57599-8814-01

$15.0000

 Preferred Blood Glucose Testing Strips - Pricing for strips is based on current WAC.  

NDC Description

NDC

FREESTYLE INSULINX 50 ct      

99073-0712-31

FREESTYLE INSULINX TEST STRIPS 100 ct

99073-0712-27

FREESTYLE LITE STRIPS 50 ct

99073-0708-22

FREESTYLE LITE STRIPS 100ct      

99073-0708-27

FREESTYLE TEST STRIPS 50ct

99073-0120-50

FREESTYLE TEST STRIPS 100ct

99073-0121-01

ONE TOUCH ULTRA TEST STRIPS 50ct 

53885-0244-50

ONE TOUCH ULTRA TEST STRIPS 100ct

53885-0245-10

ONE TOUCH VERIO TEST STRIPS 50ct
53885-0271-50 
ONE TOUCH VERIO TEST STRIPS 100ct  53885-0272-10

PRECISION XTRA 50ct              

57599-9728-04

PRECISION XTRA 100ct              

57599-9877-05

PRECISION XTRA KETONE 10CT      

57599-0745-01

 

Miscellaneous Supplies

Please keep in mind supplies used for insulin pumps will not be covered through the pharmacy POS. Please continue to bill those through DME.

SoonerCare covers most brands of the following diabetic testing supplies within the pharmacy benefit. There are no preferred products and products are reimbursed at the Medicare Competitive Bid Rate. Covered NDCs can be downloaded as a pdf here.

Supply Item

Maximum Quantity

Medicare Bid Rate / Max Price

Control Solution

One bottle per year

$3.38 per bottle
Insulin Syringes         200 per month up to $0.26 each
Ketone Urine Strips     100 per month $0.1178 per strip

Lancing Device

One device per year

$2.12 per device

Lancets

200 lancets per month

$1.42 per box of 100

Pen Needles

200 per month

up to $0.26 each

 

Billing

Effective June 1st, 2015, diabetic supply claims can be processed by SoonerCare pharmacy providers only. These claims will not count against the members monthly script limit and they will also be available with no copay.

Supplies for insulin pumps will continue to be billed through the DME process.

Claims for Medicaid/Medicare dual eligible members are not affected by this changes and should continue to be submitted to Medicare Part B.

All claims submitted will need to use the product NDC and quantity/day supply requested. (50 strips = quantity or 50).

For pharmacy providers that also have a DME provider number, please ensure that you are submitting the claim using the pharmacy provider ID. Claims for these products billed using the DME provider number will be denied.

An automated prior authorization process will look for insulin and other diabetic medications on the member’s claims history. It will also look for a diagnosis of gestational diabetes. If the medication or diagnosis is not found in claims history or if the quantity submitted exceeds the maximum allowed, the claim will deny for prior authorization. A copy of the prior authorization form can be found on the OHCA website at http://www.okhca.org/forms (Form PHARM-35) or by clicking the link below. If you have new orders for insulin or medications and supplies, submit the medication claims first, then the supply claims.  

Prior Authorization Form   

If you have questions about this information or need assistance with a claim, please call the pharmacy help desk at (800) 522-0114, option 4.