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Diabetic Testing Supplies

Drug - Diabetic Testing Supplies

October 2019

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

Preferred blood glucose testing strips

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

*100 or 102 depending on the package size

Questions?

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

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