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Diabetic Testing Supplies

Drug  - Diabetic Testing Supplies

January 2018

Therapeutic area - Diabetes Care - Test Strips and Meters

Approval criteria for nonpreferred products

  • Patient is legally blind or has reduced visual acuity so that they are unable to see the numbers on ALL of the preferred products and the requested product has a feature that enables the patient to use the meter that is not available on any of the preferred meters. The patient (not a caregiver) must be the one using the monitor/strips OR
  • Patient is currently using an insulin pump that needs specific meter compatibility to accurately dose insulin OR
  • Preferred meter is not compatible with insulin pump recipient is using OR
  • Recipient is unable to change to a preferred meter and strip combination due to a cognitive or developmental disability OR
  • Changing to a preferred meter and strip combination would create undue hardship for the recipient

Quantity limit

  • Test Strips = 200 per month
  • Meters = 1 per year

Quantity limit overrides will be approved if:

  • The patient has been stabilized on the current regimen. Stabilization on the current regimen is defined as having the prescription filled at least two times in the past 90 days AND
  • MHCP (either FFS or Managed Care) has paid for the previous two fills in excess of the quantity limit

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

Preferred blood glucose testing strips

Product (limit of 200 strips per month) NDC
Accu-Chek Aviva Plus Test Strip 65702040710
65702040810
Accu-Chek Compact Plus 50924098850
Accu-Chek Smartview Test Strip 65702049210
65702049310
Breeze 2 Disc Test Strip 00193146550
00193146621
Contour Test Strips 00193709021
00193708050
Contour Next Test Strips 00193731150
00193731221

Questions?

MHCP Provider Call Center 651-431-2700 or 800-366-5411

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