Point of Sale Diabetic Testing Supply Program

Revised: October 15, 2019

· 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. Durable medical equipment (DME) providers may not provide diabetic testing supplies to Minnesota Health Care Programs (MHCP) fee-for-service members who do not have Medicare (non-dual eligible). Enrolled pharmacy providers must dispense all diabetic testing supplies provided to MHCP fee-for-service members who do not have Medicare.

· 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 members.

Eligible Providers

Providers must enroll with MHCP 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 members 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 member 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

Members 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)	National Drug Code (NDC)
Accu-Chek Aviva Plus	65702072310
Accu-Chek Guide	65702072910 65702061710 65702070204
Accu-Chek Guide Me	65702073110
Accu-Chek Nano SmartView	65702048310 65702056710
Contour	00193718901 00193954501
Contour Next	00193737701
Contour Next EZ	00193725201 00193962801
Contour Next ONE	00193781801

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

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

Preferred Blood Glucose Testing Strips

Product (limit of 100* strips per 30 days)	NDC
Accu-Chek Aviva Plus Test Strips	65702040710 65702040810
Accu-Chek Compact Plus	50924098850 75537047419
Accu-Chek Guide	65702070195 65702071210
Accu-Chek Smartview Test Strips	65702049210 65702049310
Contour Test Strips	00193707025 00193709021 00193708050
Contour Next Test Strips	00193731025 00193731150 00193731221

* Effective Nov. 1, 2019, quantity limit of test strips will be 100 or 102 per 30 days (depending on the package size)

Nonpreferred Products: Meters and Strips

For members currently using a nonpreferred meter, coordinate a change to a preferred product. If it is medically necessary for a member to remain on a nonpreferred meter, submit an authorization request to the MHCP prescription drug prior authorization (PA) agent.

General Guidelines

MHCP may grant approval for nonpreferred products under these conditions:

· Member 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 member is using

· Member 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 member

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 are 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) minus 2%
Blood Glucose Test Strips	Wholesale Acquisition Cost (WAC) minus 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 members 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 member 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 are 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 members. Bill Medicare first, then send the crossover claim to MHCP. MHCP will pay the deductible and coinsurance amount reported on the Medicare explanation of medical benefits (EOMB). Dual eligible members are not limited to preferred brands; dispense any brand of meter or strip for dual eligible members.

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.

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