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Medicaid Approved Glucose Meters

Diabetes Health Coverage: State Laws And Programs

Diabetes Health Coverage: State Laws And Programs

Diabetes Health Coverage State Laws and Programs Diabetes Health Coverage: State Laws and Programs This is a policymaker and consumer guide to state insurance mandated coverage, Medicaid coverage and state-sponsored diabetes programs. It was published 2011and updated material was added January 2016 All state law diabetes mandates and minimum coverage requirements for state-regulated health insurance policies. The tables include the enacted state laws passedsince the firstmandates inCalifornia (1981) and New York (1993). Use links below to go directly to state-based information: State Medicaid diabetes coverage terms and conditions. All Children's Health Insurance Program (CHIP) diabetes coverage. Contact information and an overview of federal funding provided by the Centers for Disease Control and Prevention (CDC) to state-sponsored diabetes prevention and control programs (DPCPs). DPCPs represent the front line in battling diabetes in most states. An overview of other state activities and initiatives, such as creation of diabetes coordinator positions in the executive branch to fight diabetes. Federal Health Reform.The federal Affordable Care Act (ACA) signed March 2010, has led to changed and expanded coverage termed "EssentialHealth Benefits." Newly Released: NCSL Survey:Diabetes Drug coverage: A new survey of2016 Insurance Plans in 50 states, examining 1) patient access to the scores of diabetes drug treatments and2) results in the 46 states with laws mandating or offering diabetes coverage. NCSL original research, published summer 2016. [Read the report] December 2015: " Diabetes: Addressing the Costs; A 50-State Budget Survey for FY 2014 ." NCSL released its latest diabetes report, taking a closer look at programs and budget appropriations that play a role in con Continue reading >>

Newsflash: Medicare Can Cover Some Cgms Now!

Newsflash: Medicare Can Cover Some Cgms Now!

Huuuuge news in the Diabetes Community!!! In a surprise move late last week, the Centers for Medicare and Medicaid Services (CMS) issued a policy decision allowing for certain continuous glucose monitors (CGM) to be covered under Medicare! This important 16-page ruling on Jan. 12 came after business hours on the East Coast, and it was the JDRF -- one of the organizations that's led advocacy efforts on this issue for several years -- that put the word out right away among the D-Community. There are several reasons why this is a really big deal: CGM is a powerful therapy tool, one that can in particular save lives of people who experience hypoglycemia unawareness, or have dramatic highs and lows. SO naturally, it should be covered by insurance With Medicare refusing to cover it, patients using CGM who hit Medicare age were suddenly losing access to this important tool, which is nonsensical and frankly, unethical Classifying CGM as core therapy rather than "supplemental" paves the way not only for broader coverage of CGM across the board, but also for Artificial Pancreas systems on the near horizon What Exactly Has Changed: Up until now, CMS has considered CGM technology to be "precautionary," meaning it was classified as a supplemental type of device that wasn't medically necessary. CGM also didn't fall under the "Durable Medical Equipment" category that covers other diabetes devices and supplies, therefore it wasn't eligible for Medicare coverage. That now changes. A critical step that led to this CMS decision was the FDA's ruling in December that the Dexcom G5 specifically is accurate enough to be used for insulin dosing and treatment decisions. Thanks to that landmark FDA decision, the Medicare and Medicaid agency could now consider CGM "therapeutic" and classify it as Continue reading >>

Diabetic Supplies

Diabetic Supplies

For more specific results, select both a chapter and section. To move from section to section within a chapter, use the left navigation bar. For best results, select a recommended search term if one appears in the search box. To narrow your search, use the Filter By and Additional Keywords features in the left navigation bar. To find an exact phrase, use quotes (e.g., prior approval). To find all search terms, use the word AND in capital letters between search terms. To find at least one search term, use the word OR in capital letters between search terms. Blood Glucose Meters and Testing Supplies HIP Commercial, EmblemHealth Medicaid, EmblemHealth Medicare HMO, EmblemHealth Medicare PPO and Medicare Prescription Drug Plan Members For the above plan members, EmblemHealth will cover blood glucose meters and testing supplies for Abbott Diabetes Care products only. For EmblemHealth Medicaid members, this coverage went into effect October 1, 2011. Patients who need a change in their testing frequency or the type of meter or supplies used will need a new prescription. Patients new to our plans may obtain a prescribed Abbott meter at no cost by calling1-888-522-5226 or by visiting theAbbott Diabetes Care website: www.AbbottDiabetesCare.com . Questions, product support or meter replacement? Please direct your EmblemHealth patients to call Abbott Diabetes Care Product Support at 1-888-522-5226 or go online at www.AbbottDiabetesCare.com . EmblemHealth EPO/PPO, GHI HMO, GHI PPO and GuildNet Plan Members Items not requiring prior approval, such as blood glucose meters and diabetic testing supplies (with the exception of insulin pumps and related supplies, which do require approval), may be directly requested from CCS Medical for the above-referenced plan members. EmblemHealth's f Continue reading >>

Does Medicare Cover Diabetes-related Medical Expenses?

Does Medicare Cover Diabetes-related Medical Expenses?

Medicare covers supplies for people with diabetes, whether or not they use insulin. These include glucose testing monitors, blood glucose test strips, lancet devices and lancets, and glucose control solutions. There may be some limits on supplies or how often you get them. Medicare also covers the cost of therapeutic shoes, self-management training, nutrition counseling, flu and pneumococcal pneumonia shots, and glaucoma screening for people with diabetes. For more information, see Medicare Coverage of Diabetes Related Supplies and Services at the Medicare Web site. In addition, Medicare beneficiaries aged 65 years and older who have diabetes and haven’t had a medical eye exam in the past three years can receive a free comprehensive eye exam and up to one year of follow-up care for any condition diagnosed at the initial exam. Does Medicaid cover diabetes-related medical expenses? Medicaid is a state administered program and each state sets its own guidelines regarding eligibility and services. Visit the Medicaid Site for Consumer Information to locate information by state. How do I figure the cost of diabetes for my company? Where can I find free or low-cost diabetes coverage and services? The Bureau of Primary Health Care within the Health Resources and Services Administration (HRSA) has a nationwide network of community-based health care centers that provide primary health care services at little or no cost. Hospitals and other health care facilities participating in HRSA’s Hill-Burton Program provide free and low-cost services to eligible individuals. The State Children’s Health Insurance Program (SCHIP) provides free or low-cost health insurance for children. The Partnership for Prescription Assistance provides information about public and private patient assi Continue reading >>

Insurance Resources For Persons With Diabetes

Insurance Resources For Persons With Diabetes

Lack of health insurance is a major obstacle to managing diabetes. Below are links regarding options for obtaining health insurance in Texas, and frequently asked questions about diabetes equipment, supplies, medication and training that may or may not be covered by certain types of health plans. The Texas Diabetes Council does not provide or guarantee insurance coverage. It is the responsibility of the individual seeking health insurance to provide information related to eligibility and other application information to the appropriate insurance provider when seeking coverage. External links to other sites are intended to be informational and do not have the endorsement of the Texas Department of State Health Services. These sites may not be accessible to persons with disabilities. Texas Health Options Consumer information from the Texas Department of Insurance about finding group coverage, determining whether you qualify for Medicaid or Medicare, applying for coverage through the Texas Health Insurance Pool, or buying an individual policy. Includes information about plans available through the federal health insurance marketplace (www.HealthCare.gov). Texas Medicaid Site provides a list of Medicaid services in Texas, including eligibility criteria. Medicaid is the State and Federal cooperative venture that provides medical coverage to eligible needy persons. Texas Children’s Health Insurance Program (CHIP): The Children’s Health Insurance Program (CHIP) is a national program designed for families who earn too much money to qualify for Medicaid, yet cannot afford commercial insurance. Coverage is available for qualified children from birth through age 19). Medicare Formerly the Health Care Financing Administration (HCFA), now the Centers for Medicare & Medicaid Serv Continue reading >>

Preferred Drug List | Mississippi Division Of Medicaid

Preferred Drug List | Mississippi Division Of Medicaid

PDLchanges provider notice : effective April 1, 2018 The PDL is a medication list recommended to DOM by the P&T Committee and approved by the executive director of DOM. Drugs designated as preferred have been selected for their efficaciousness, clinical significance, cost effectiveness and safety for Medicaid beneficiaries. The PDL addresses certain drug classes: Some drug classes will not be reviewed for preferred status because of no and/or limited cost savings, if the class is all and/or mostly generic, or if there is low utilization in that class. Drugs, historically covered by Medicaid and not listed on the PDL, will continue to be covered. DOM may opt to include or delete drug classes from PDL review in the future. New drugs introduced into the marketplace in therapeutic classes that have been reviewed will be considered non-preferred until no later than the annual review of the particular therapeutic class. Not reviewed (NR) notation on the PDL document indicates a new drug that has not yet been reviewed by the P&T Committee. Drugs highlighted in yellow, on the PDL document, denote a change in PDL status. Preferred brands do not count toward the monthly brand service limit. However, preferred brands count toward the drug service limit of 5/month. Unless otherwise specified, the listing of a particular brand or generic name includes all dosage forms of that drug. Medicaid-covered drugs noted as non-preferred will continue to be available through the prior authorization process. A three-day emergency supply of prior-authorized drugs can be dispensed by a pharmacy until authorization is completed. Continue reading >>

Glucose Monitoring Device Approved For Medicare, Medicaid

Glucose Monitoring Device Approved For Medicare, Medicaid

Glucose Monitoring Device Approved for Medicare, Medicaid Abbott Laboratories said on Thursday its newly launched glucose monitoring device would be covered by the Centers for Medicare & Medicaid Services, expanding its usage to millions of diabetes patients in the United States. The device, FreeStyle Libre Flash, was approved by the U.S. Food and Drug Administration in September. It allows diabetes patients to continuously track blood sugar levels without having to prick their fingers. Abbott's device is the second continuous glucose monitoring system after DexCom Inc's G5 Mobile to be covered by the federal agency. DexCom's device is similar to Abbott's, but requires fingertip testing about two to four times a day for optimal accuracy. Abbott's device has a retail price of $70 for a reader and $36 per sensor, which lasts for 10 days. "(This) cost is much less than other CGM systems that are available commercially," said Jared Watkin, senior vice president of Abbott's Diabetes Care unit. Watkin added that the Medicare pricing would be different as it is based on certain reimbursement codes. CMS rolled out deep cuts to reimbursement rates for certain laboratory and diagnostic tests under Medicare in November, a move that could save the government about $670 million in Medicare payments in 2018. The reimbursement rates for the CGM system under the existing codes are $3,000 for a year, of which the federal agency pays $2,400 and the rest is paid out of pocket by the patients, Watkin said. "Those codes can change," he added. 2018 Thomson/Reuters. All rights reserved. Continue reading >>

What You Should Know About Medicaid And Diabetes

What You Should Know About Medicaid And Diabetes

Medicaid is a government run health insurance program for poor and disabled people. According to the American Diabetes Association 3.5 million people with diabetes use Medicaid for all or some of their medical care. Ongoing and preventive health care is particularly important for people with diabetes to avoid costly medical complications. Many suggested changes to Medicaid may affect the level of care received by Medicaid recipients. Medicaid is often confused with Medicare. Medicare applies to all elderly, regardless of income and younger poorer individuals who have disabilities. Medicare for older individuals is not dependent on the individual being poor. Medicaid, however, has restrictions on the amount of assets an individual may have and/or the amount of income an individual can receive to be able to receive Medicaid assistance. Often the distinction is made that MedicAID means “assets and income depleted.” Medicare and Medicaid together cover over half the money that is spent on long term care in this country. The specific restrictions on Medicaid applicability is set by individual states. Some states limit income and some do not. The Federal Deficit Reduction Act (DRA) of 2005 made major changes to Medicaid eligibility requirements. In response to this Federal mandate, states have been tightening up their applicability requirements. For example, many states now look back for five years when determining if an individual has been giving assets away in a way that is prohibited by Medicaid eligibility rules. Any assets that have been given away contrary to Medicaid regulations may subject the donor to sanctions. The Affordable Care Act (ACA) of 2010, have also had effects on Medicaid. The ACA requires states to provide certain benefits to individuals. To be able Continue reading >>

Florida Medicaid Preferred Drug List (pdl)

Florida Medicaid Preferred Drug List (pdl)

Florida Medicaid Preferred Drug List (PDL) The Florida Medicaid Preferred Drug List is subject to revision following consideration and recommendations by the Pharmaceutical and Therapeutics (P&T) Committee and the Agency for Health Care Administration. The Changes Summary Report lists only changes made to the Preferred Drug List as a result of the P&T Committee meeting on January 19, 2018. It does not include changes made between meeting dates. Always refer to the Preferred Drug List document for the most current list of preferred drugs. Changes Summary Report [109KB PDF] Updated 02/16/2018 The Preferred Drug List was updated from the January 19, 2018 P&T Committee meeting. Open the attached list and use the Adobe Acrobat search tool to locate specific drugs by name or HIC3 therapeutic class. Please read the first page for important additional information and definitions. Preferred Drug List [1.10MB PDF] Updated 02/16/2018 Important information regarding quantity and/or age limits for various drugs may be found at the following link: Continue reading >>

New: 2017 Diabetic Meter Program

New: 2017 Diabetic Meter Program

News Effective January 30, 2017, Superior HealthPlan will launch a Preferred Diabetic Meter Program. Superior’s preferred brand of blood glucose meter and test strips will be from TRUE METRIX. These supplies will be available to members at no cost. A letter has been sent to members notifying them of this new program, with information on how to receive new blood glucose supplies. Frequently Asked Questions: When does this program go into effect? Effective January 30, 2017, the program will be available to members with no prescription claim history for a meter or supplies. For members with a history of prescription claims for other meters, the program will take effect on March 1, 2017. How do members get a new, preferred blood glucose meter? In order for members to receive the preferred blood glucose meter at no cost, providers will need to write a prescription for a TRUE METRIX Air or TRUE METRIX Meter. Prescribers will also need to ensure the member takes the prescription and the processing information (in the table below) to a drug store or pharmacy in Superior’s network. List of Preferred Diabetic Meters Claims Processing Information TRUE METRIX AIR TRUE METRIX Meter Rx BIN Number: 015251 PCN Number: PRX2000 Identification Number: HB224289445 Group Number: TRUEPORT22 What happens when a member fills their prescription? When members attempt to fill their prescription for a meter, a point-of-sale message will direct the pharmacist to dispense a TRUE METRIX Air or TRUE METRIX Meter and corresponding test strips (if applicable) to the member at no charge. What if the pharmacy does not have the meter in stock? If the pharmacy does not have the preferred meter in stock, they can either order the meter or redirect the member to another in-network pharmacy. The member can Continue reading >>

Mississippi Envision

Mississippi Envision

2. Does the pharmacy program ever reimburse for a non-covered drug for children? While there are many services not covered under the Division of Medicaid's state plan for pharmacy, there are circumstances that may allow coverage through EPSDT (refer to Policy Manual Section 73.09). Pharmacy providers are encouraged to contact the Bureau of Pharmacy at 601-359-5253. 3. Do children have monthly prescription limits? In cases of medically necessity, requests for more than the monthly benefit limits i.e. more than 5 prescriptions monthly or more than 2 brand name drugs for beneficiaries under the age of 21 are to be submitted via fax to Health Information Designs (HID) at 1-800-459-2135. There is no change in policy regarding drug benefits for children. Medically necessary prior authorization form for beneficiaries less than 21 may be found DOM's web site at www.medicaid.ms.gov , Pharmacy Services, and forms. Or call Health Information Designs at 1-800-355-0486. 4. Is DAW 7 still active for Narrow Therapeutic Index (NTI) drugs? Do NTI drugs count against the 2 brand limit? DAW 7 is still active for NTI Drugs. All legend brand name drugs, including NIT drugs, count against the 2 brand monthly limit. Some Narrow Therapeutic Index drugs have been added to the 90 Day Maintenance list. Please refer to DOM's web site at www.medicaid.ms.gov , Pharmacy Services, for most current 90 Day Maintenance List. 5. What pharmacy services are covered for beneficiaries who are in the Family Planning Waiver and have a `yellow Medicaid card? Beneficiaries enrolled in the Family Planning Waiver are eligible for Medicaid coverage of family planning services only and are not eligible for any other Medicaid services. The Family Planning Waiver program is a collaborative venture of the Mississippi D Continue reading >>

Nc Medicaid Expects To Save Millions With New Diabetic Supplies Vendor

Nc Medicaid Expects To Save Millions With New Diabetic Supplies Vendor

NC Medicaid announced Tuesday that it expects to save $6 million annually through a sole-source for diabetic supplies. Roche Diagnostic Corp, maker of the Accu-Chek line of blood glucose meters and test strips, beat eight competitors for the contract, which took effect November 15, 2011, and will run for one year, with options for another two years. The Division of Medical Assistance (DMA), North Carolinas Medicaid agency, entered a similar arrangement two years ago with Prodigy Diabetes Care. That contract expired November 14, 2011. DMA is working with both Roche and Prodigy on a transition plan that will extend into January 2012. During the transition period, Roche will provide a glucose meter to the nearly 77,000 NC Medicaid and NC Health Choice members living with diabetes. As under the previous contract, other brands will be available on a prior-approval basis for specific medical circumstances. The meters are free. DMA will pay for disposable test strips, control solution, lancets and lancing devices. Insulin syringes, which Prodigy supplied under the expiring contract, are no longer a sole-source item. Continue reading >>

Cms Defines Certain Continuous Glucose Monitors As Dme

Cms Defines Certain Continuous Glucose Monitors As Dme

On January 12, the Centers for Medicare & Medicaid Services (CMS) announced a ruling that would classify certain continuous glucose monitors (CGMs) as durable medical equipment (DME), a significant step toward making them eligible for coverage under Medicare. “Continuous blood glucose monitors are important for people with diabetes because they help people to get better diabetes control,” Cynthia Rice, JDRF senior vice president for advocacy and policy for diabetes funding and research group JDRF told Medical Economics. “Extensive research has shown better diabetes outcomes when using CGMs, which is why all guidelines recommend them for patients with type 1 diabetes and why nearly all private insurance plans cover them.” Defining DME Until recently, CMS did not cover CGM devices under Medicare, although regular blood glucose monitors have been covered since the early 1980s. CMS defines DMEs as items that can withstand repeated use, have an expected life of at least 3 years, are primarily used for a medical purpose, are not useful to someone without illness and are appropriate for use in the home. According to the ruling, the FDA recently approved expanding the indications of one CGM product to include replacement of blood glucose monitors for diabetes treatment decisions, as opposed to using CGM as a complement to regular blood glucose monitors. Under the FDA definition, interpretation of the CGM results should be based on the glucose trends and several sequential readings. In addition, the CGM can aid in detection of episodes of hyperglycemia and hypoglycemia, allowing for acute and long-term therapy adjustments. “Based on this information, the therapeutic CGM is designed and approved to replace a blood glucose monitor currently classified as DME under the Me Continue reading >>

Indiana Medicaid For Members

Indiana Medicaid For Members

Beginning January 1, 2011, a Preferred Diabetic Supply List(PDSL) will be implemented. You will need to start using one of the blood glucose monitorslisted in the table below. If you have a blood glucose monitor thatis not on the list below, you will need to speak with your doctorto get a new prescription for one of the blood glucose monitors andtest strips listed below. New blood glucose monitors and teststrips will be provided at no cost to you. If you alreadyhave one of the blood glucose monitors listed below, you do notneed to do anything. What if I need a monitor not on this list? If you have a medical condition that prevents you from using oneof the blood glucose monitors listed above, you or your pharmacywill need to speak with your doctor and ask him to request a priorauthorization for a different blood glucose monitor and teststrips. You may continue to use the same provider(s) for your diabeticsupplies as you do now, and you will continue to receive theseproducts at no charge to you. If you have questions about this change, please contact theIndiana Health Coverage Programs (IHCP) Members Hotline at1-800-457-4584. If you have questions about any of the products on the PDSL,please contact the manufacturer for that product (listed above).The Abbott Diabetes Care Product Support Line and Roche DiagnosticsCustomer Care Center are available 24 hours a day, seven days aweek for product assistance. Continue reading >>

Centers For Medicare & Medicaid Services (cms) Classify Therapeutic Continuous Glucose Monitors (cgm) As

Centers For Medicare & Medicaid Services (cms) Classify Therapeutic Continuous Glucose Monitors (cgm) As "durable Medical Equipment" Under Medicare Part B

Centers for Medicare & Medicaid Services (CMS) Classify Therapeutic Continuous Glucose Monitors (CGM) as "Durable Medical Equipment" under Medicare Part B January 12, 2017 09:30 PM Eastern Standard Time SAN DIEGO--( BUSINESS WIRE )--DexCom, Inc. (NASDAQ:DXCM), the leader in continuous glucose monitoring (CGM) for people with diabetes, is pleased to announce the determination of a benefit category and coverage for CGM by CMS. In order to be included in this category, the system must be defined as therapeutic CGM, meaning you can make treatment decisions using the device. Today, the Dexcom G5 Mobile is the only CGM system that falls within this classification. A link to the full CMS Ruling No. CMS-1682-R can be found at www.cms.gov/Regulations-and-Guidance/Guidance/Rulings/Downloads/CMS1682R.pdf . This landmark CMS Ruling will make available the most important technology in diabetes management to the Medicare population, said Kevin Sayer, Dexcom President and Chief Executive Officer. We are pleased with this important step forward and we look forward to working with Medicare on implementing coverage in the coming months to ensure beneficiaries have access to this life-saving device. About Diabetes and Continuous Glucose Monitoring With diabetes, the body cannot produce or use the hormone insulin effectively, causing a buildup of glucose, or sugar, in the blood. People with diabetes who take insulin must monitor their blood glucose levels frequently. Uncontrolled glucose can cause health complications and even death.i,ii Continuous glucose monitoring (CGM) is considered the most significant breakthrough in diabetes management in the past 40 years.iii CGM is important because, in addition to providing the glucose level, it provides the direction and rate of glucose change Continue reading >>

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