Medicaid Diabetic Supply Information Reference Guide

A Note to Providers:

Previous bulletins and/or communications from Meridian in May and June highlighted specific diabetic supplies, and indicated these supplies were covered by the member’s pharmacy benefit. We have created this resource to provide clarification on the specifics of coverage for diabetic supplies and any prior authorization requirements. Please reach out to your provider representative with any questions you may have regarding diabetic supply coverage for Medicaid members.

Product:	Current Benefit Type:	Dispensed by:	Additional Information
Continuous Glucose Monitor components including sensors, transmitters, receivers (Dexcom, Freestyle Libre, Guardian, Eversense)	Pharmacy or Medical	Pharmacy or DME	Prior authorization required under pharmacy benefits Prior authorization required under medical benefits
Wearable insulin delivery system (Omnipod, V-Go, Cequr)	Pharmacy or Medical	Pharmacy or DME	Prior authorization required under pharmacy benefits Prior authorization required under medical benefits
Traditional Insulin Pumps (iLet, Medtronic, Tandem t:slim)	Medical	DME	Prior authorization required under medical benefits
Blood Glucose Test Strips	Pharmacy or Medical	Pharmacy or DME	Prior authorization NOT required under pharmacy benefits for preferred product OneTouch Verio Test Strips for claims within the Quantity Limit of 250 strips per 30 days Prior authorization required under pharmacy benefits for other test strip brands as nonpreferred products Prior authorization NOT required under medical benefits
Blood Glucose Glucometers	Pharmacy* or Medical	Pharmacy or DME	Prior authorization NOT required under pharmacy benefits for preferred product OneTouch Verio Flex Meter* Pharmacy rejection message redirects to billing information for free OneTouch Verio Flex Meter from manufacturer Prior authorization required under pharmacy benefits for other glucometers as nonpreferred products Prior authorization NOT required under medical benefits *All Glucometers including OneTouch Verio Flex Meter will reject at pharmacy point of sale
Lancets	Pharmacy or Medical	Pharmacy or DME	Prior authorization NOT required under pharmacy benefits Many preferred brands under pharmacy benefits (such as OneTouch, Accu-chek) Prior authorization NOT required under medical benefits
Insulin Syringes & Pen Needles	Pharmacy or Medical	Pharmacy or DME	Prior authorization NOT required under pharmacy benefits Prior authorization NOT required under medical benefits
Alcohol Prep Pads	Pharmacy or Medical	Pharmacy or DME	Prior authorization NOT required under pharmacy benefits Prior authorization NOT required under medical benefits
Ketone Urine Test Strips	Medical	DME	Prior authorization NOT required under medical benefits
Protein Urine Test Strips	Medical	DME	Prior authorization NOT required under medical benefits

Footnotes

Pharmacy benefit prior authorizations can be initiated either to fax number 877-355-8070, or electronic prior authorization completed online through Covermymeds.com
Pharmacy resources and formulary information can be found on the Pharmacy page
Medical benefits prior authorizations can be initiated either to fax number 833-341-2049, or online through the provider portal
Medical benefit procedure codes (CPT codes) coverage status can be verified online through Meridian’s website with the Medicaid Pre-Auth Check Tool (Select “NO” for each answer to the questions for Types of Services, then enter the code of the service you would like to check)

Last Updated: 07/05/2024