Diabetic supplies covered under the Prescription Drug Benefit


Not including insulin and prescription medication.

 
Item Coverage Benefit
Accu-chek Meter No Copay** Prescription drug
Accu-chek Test Strips and solutions Tier 2 Prescription drug
Freestyle Meter No Copay** Prescription drug
Freestyle Test Strips and solutions Tier 2 Prescription drug
Precision Xtra Meter No Copay** Prescription drug
Precision Xtra test strips Tier 2 Prescription drug
Alcohol Pads Tier 1 Prescription drug
Lancets Tier 1 Prescription drug
BD Insulin Syringes Tier 1 Prescription drug
Freestyle Insulin Syringes Tier 1 Prescription drug
Precision Insulin Syringes Tier 1 Prescription drug
BD Pen Needles Tier 1 Prescription drug
Novofine Pen Needles Tier 1 Prescription drug
Novotwist Pen Needles Tier 1 Prescription drug
All other Diabetic Supplies (syringes, test strips, meters) Tier 3 Prescription drug

**No member responsibility under either the prescription drug benefit or the medical DME benefit
Benefits listed subject to change. To obtain specific, documented benefit information, please contact Prevea360 Health Plan Customer Care Center at 877.230.7555. 

Diabetic supplies covered through medical benefits

  • Insulin infusion pumps and cartridges are applied to the member’s DME benefit.
  • Supplies such as prep wipes, batteries, infusion sets, etc. are applied to the member’s diabetic supply benefit. 
  • Insulin Pumps may be supplied by MiniMed Distribution, Animas, Insulet Corporation and Dexcom. (MiniMed has an insulin pump that uses a BD glucose monitor with it. Prevea360 Health Plan will cover the supplies for the BD glucose monitor when used in conjunction with an insulin pump. The test strips are not on the drug formulary but the doctor can send in a prior authorization request for pump wearers to get the strips from a pharmacy.)
  • Insulin Supplies may be obtained from MiniMed Distribution (Medtronic), Animas, Insulet Corporation (Omnipod) and Dexcom (limited to: sensors, transmitter and receiver)
  • DHI does not require authorization for insulin pumps and supplies regardless of the cost, when obtained from a plan provider.
  • Blood Glucose Monitors may be obtained from a Plan Pharmacy.  
  • Glucagon emergency kits are covered under the member’s diabetic benefit.  Member is able to get one kit per copay

Supplier contact information

Minmed Distribution (Medtronic): 800.646.4633
Animas: 610.644.8990
Insulet Corp. (Omnipod): 978.600.7000
Dexcom: 877.339.2664