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Point of Sale Diabetic Testing Supply Program

Revised: 02-10-2017

  • Overview
  • Eligible Providers
  • Eligible Recipients
  • Pharmacy POS Benefit
  • Preferred Products: Blood Glucose Meters and Strips
  • NonPreferred Products: Meters and Strips
  • Miscellaneous Supplies
  • Payment Rates
  • Billing
  • Additional Resources
  • Overview

    Diabetic testing supplies, including meters, test strips, lancing devices, and lancets, are part of the pharmacy point of sale (POS) benefit. DME providers may not provide diabetic testing supplies to MHCP fee-for-service recipients who do not have Medicare (non-dual eligible). All diabetic testing supplies provided to MHCP fee-for-service recipients who do not have Medicare must be dispensed by enrolled pharmacy providers.

  • • Medical DME suppliers or other providers who are not enrolled as pharmacy providers may not bill MHCP for diabetic testing supplies
  • • Enrolled pharmacies who provide diabetic testing supplies to non-MHCP customers must provide them to MHCP recipients
  • Eligible Providers

    Providers must be enrolled and meet at least one of the following criteria:

  • • A pharmacy that is licensed by the Minnesota Board of Pharmacy
  • • An out-of-state pharmacy, licensed by a state board of pharmacy, that applies for retroactive enrollment
  • • A physician located in a local trade area where there is no MHCP enrolled pharmacy. The physician, to be eligible for payment, must personally dispense the diabetic supply according to applicable Minnesota statutes, and must adhere to the labeling requirements of the Minnesota Board of Pharmacy
  • Eligible Recipients

    All MHCP recipients are eligible for a certain level of pharmacy and medical supply benefits. See Health Care Programs and Services for specific program coverage. Use MN–ITS Eligibility Request (270) to verify recipient eligibility and other insurance coverage. Programs with limited prescription drug coverage include:

  • • Emergency Medical Assistance (EMA): See the Emergency Medical Assistance section for services not available
  • • Program HH ADAP Drug Formulary
  • Recipients eligible for both MHCP and Medicare (dual eligibility) must receive their supplies through Medicare.

    Pharmacy POS Benefit

    MHCP covers diabetic testing supplies, including meters, test strips, lancing devices, lancets and control solution, at the pharmacy point of sale (POS). Blood glucose meters and test strips are part of MHCP’s preferred diabetic testing supply program which lists preferred and nonpreferred products. Nonpreferred products require prior authorization.

    Preferred Products: Blood Glucose Meters and Strips

    MHCP prefers the following brands of diabetic testing supplies. These products do not require prior authorization. All other blood glucose meters and strips will require prior authorization.

    Preferred Blood Glucose Monitors

    Product (limit of one meter per year)

    NDC

    Accu-Chek Aviva Plus

    65702010110

    Accu-Chek Nano SmartView

    65702048310

    Contour

    00193715101

    Contour Next

    00193737701

    Contour Next EZ

    00193725201

    Contour Next USB

    00193741101

    Contour USB

    00193739301


    Recipients requesting additional meters (more than one per year) are instructed to call the manufacturer and request an additional meter.

    Accu-Check Customer Service: 800-858-8072
    Contour Customer Service
    : 800-401-8440

    Preferred Blood Glucose Testing Strips

    Product (limit of 200 strips per month)

    NDC

    Breeze 2 Disc Test Strip

    00193146550
    00193146621

    Accu-Chek Aviva Plus Test Strips

    65702040710
    65702040810
    65702059110

    Accu-Chek Smartview Test Strips

    65702049310
    65702049210
    65702059110

    Contour Test Strips

    00193709021

    Contour Next Test Strips

    00193731150
    00193731221
    00193708050


    Nonpreferred Products: Meters and Strips

    For recipients currently using a nonpreferred meter, coordinate a change to a preferred product. If it is medically necessary for a recipient to remain on a nonpreferred meter, submit an authorization request to the MHCP Prescription Drug PA Agent.

    General Guidelines

    Approval may be granted for nonpreferred products under these conditions:

  • • Recipient is blind or has reduced visual acuity – approval of talking meter, such as Prodigy Voice or Glucocard® Expression™
  • • Preferred meter is not compatible with insulin pump recipient is using
  • • Recipient is unable to change to a preferred meter and strip combination due to a cognitive or developmental disability
  • • Changing to a preferred meter and strip combination would create undue hardship for the recipient
  • Miscellaneous Supplies

    MHCP 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 will be listed on the NDC Search website.

    Supplies included in pharmacy POS benefit program

    Supply Item

    Maximum Quantity

    Control solution

    One bottle per month

    Lancing device

    One device per month

    Lancets

    400 lancets per month


    Supplies NOT included in pharmacy POS program

    The following supplies are not included in the pharmacy POS diabetic testing supply program:

  • • Alcohol swabs
  • • Syringes and needles
  • • Insulin pump supplies
  • Payment Rates

    Payment rates for diabetic testing supplies billed through the pharmacy POS benefit will be:

    Product

    Payment rate

    Blood Glucose Meters

    Wholesale Acquisition Cost (WAC) plus 2%

    Blood Glucose Test Strips

    Wholesale Acquisition Cost (WAC) plus 2%

    Control Solution

    Medicare Competitive Bid Rate

    Lancing Device

    Medicare Competitive Bid Rate

    Lancets

    Medicare Competitive Bid Rate


    MHCP will not pay a pharmacy dispensing fee for diabetic testing supplies.

    Billing

    Submit claims for MHCP fee-for-service recipients using the appropriate NDC codes. Continue to bill MHCP for supplies not included in the POS benefit as DME using the appropriate HCPCS codes on the 837P claim. Providers must dispense an entire unopened box of test strips or lancets. To minimize waste, dispense the manufacturers smallest package size available. If the smallest package exceeds a day’s supply of 180 days, enter 180 days as the day supply. For example, if the patient tests once weekly, dispense a box of 25 test strips (175 day supply) and a box of 100 lancets (180 day supply).

    FQHC, RHC and IHS

    Federally qualified health centers (FQHCs), rural health clinics (RHCs) and Indian Health Services (IHS) providers, including IHS pharmacies, do not receive a separate encounter rate for dispensing medical supplies, including diabetic testing supplies. FQHCs, RHCs and IHS facilities are not required to use the preferred products and may submit pharmacy POS claims or 837P claims for any brand of meter and strips without prior authorization. All claims for medical supplies, including diabetic testing supplies submitted by FQHCs, RHCs and IHS pharmacies will be paid at zero because the supplies are considered incidental to paid encounters.

    Dual Eligible Recipients

    Do not bill the MHCP pharmacy POS benefit for diabetic testing supplies dispensed to Medicare dual eligible recipients. Bill Medicare first, then send the crossover claim to MHCP. MHCP will pay the deductible and coinsurance amount reported on the Medicare EOMB. Dual eligible recipients are not limited to preferred brands; dispense any brand of meter or strip for dual eligible recipients.

    Private Insurance

    Follow the rules of other insurance, including use of preferred products, network providers, authorizations and billing requirements when dispensing pharmacy POS diabetic supplies. MHCP authorization is not required if the other insurance pays 60 percent or more of the allowed rate for a nonpreferred meter or test strips.

    Additional Resources

    NDC Search

    Fee-for-Service PA Criteria Sheet – Diabetic Testing Supplies

    If you have questions about this information, call the MHCP Provider Call Center at 651-431-2700 or 800-366-5411.

    Sign up to receive Provider Updates and other MHCP notices in your email account.

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