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Medicaid-Covered Diabetic Supplies Now Processed Through Pharmacy - page 2 / 8

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PHP preferred diabetic supplies and quantity limits are listed below.

Diabetic Supply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . Maximum Quantity Limit (QL)

Blood Glucose Meter*

..................................

1 meter per year

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Insulin Users – QL 100/25 Non-Insulin Users – QL 50/25 or 100/50 Members less than 18 years old QL 200/30 Members with gestational diabetes – up to 300/30 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 per every 6 months Blood Glucose Test Strips * Lancing Devices . . . . . . . . .

Lancets. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200 per month Syringe w/needle. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 per month

Pen Needles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 per month

Urine Glucose Test, Strip . . . . . . . . Urine Acetone Test, Tablet/Strip

. . . . . . . . . . . . . . . . . . . . . . . 200 per month . . . . . . . . . . . . . . . . . . . . . . . 200 per month

Urine Glucose-Acetone Combination Test Strip . . . . . 200 per month

*Bayer Breeze®2, Contour®, Acensia® preferred.

Note: ๎€ทis listing is also available on the PHP web site at www.passporthealthplan.com/pharmacy.

  • ๎•

    is requirement does not apply to PHP members who have Medicare or other coverage as primary,

including all Passport Advantage members. DME providers may still provide diabetic supplies to those members.

Provider Action Needed: For PHP members without Medicare or other primary coverage, you must now write a prescription for these diabetic supplies and refer members to the pharmacy. ๎•ese diabetic supplies are no longer available or billable through DME.

For PHP members with Medicare or other primary coverage (such as Passport Advantage, Original Medicare, etc.), please continue to order and submit claims for these diabetic supplies and all other DME supplies as normal.

Pharmacy Reimbursement

  • ๎•

    ese diabetic supplies will continue to be reimbursed at pharmacies’ current contracted rate.

Questions: Pharmacies should contact the PerformRx Help Desk at (800) 578-0898. Providers should contact your Provider Relations representative or the Provider Relations department at (502) 585-7943.

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