CurrentAlaska MedicaidPolicy N/A

Immediate Action Needed to Ensure Access to Diabetic Supplies

Notice to Alaska Medicaid recipients who are dually eligible for Medicare and Medicaid that pharmacies must bill Medicare Part B first for diabetic testing supplies; affects recipients, pharmacies, suppliers, and prescribers in Alaska.

Policy Summary

PayerAlaska Medicaid

PolicyImmediate Action Needed to Ensure Access to Diabetic Supplies

Policy CodePolicy N/A

Change TypeNotice (no material change)

Effective DateMarch 21, 2025

Next Review DateN/A

Key ActionContact your current pharmacy to confirm they can bill Medicare Part B and transfer the prescription to a Medicare-enrolled supplier if they cannot.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Medicare Part B billed firstpayer of first resort requirement for diabetic supplies

907-269-3680 / 1-800-478-6065Alaska Medicare Info - phone

hss.medicare@alaska.govAlaska Medicare Info - email

Medicaid payer of last resortlegal billing principle

Billing rules for diabetic testing supplies

Policy Summary

PayerAlaska Medicaid

PolicyImmediate Action Needed to Ensure Access to Diabetic Supplies

Policy CodePolicy N/A

Change TypeNotice (no material change)

Effective DateMarch 21, 2025

Next Review DateN/A

Key ActionContact your current pharmacy to confirm they can bill Medicare Part B and transfer the prescription to a Medicare-enrolled supplier if they cannot.

SourceLink

On This Page

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Recipient is dually eligible for Medicare and Alaska Medicaid and has Medicare Part B

Medicare Part B must be billed first by the pharmacy or supplier before Alaska Medicaid will pay.

ALL of the following

Pharmacy must submit claim to Medicare Part B before billing Alaska Medicaid
If pharmacy does not submit claims to Medicare Part B before billing Medicaid, the claims will be denied.
If pharmacy cannot bill Medicare Part B
- Recipient must transfer prescription to a Medicare-enrolled pharmacy or supplier
  Use a Medicare-enrolled supplier or mail-order supplier that bills Medicare Part B.
- Pharmacy should confirm ability to bill Medicare Part B and any required paperwork; if unable, assist with transfer
  Contact current pharmacy to confirm capability and transfer prescription as needed.

Consequences of not billing Medicare Part B first

Claims will be denied by Alaska Medicaid and the recipient may owe out-of-pocket costs.

ALL of the following

Locate a Medicare-enrolled pharmacy or supplier
Find and confirm a Medicare-enrolled pharmacy or supplier using Medicare.gov and confirm they accept new clients and can provide diabetic supplies.
Notify prescriber to update and send prescriptions
Instruct prescribers to update and send prescriptions to the Medicare-enrolled pharmacy or supplier as needed.
Act quickly to avoid interruption in service
Work with your pharmacy and prescriber to ensure supplies are ordered from a pharmacy or supplier enrolled to bill Medicare Part B.

Actions for pharmacies, suppliers, and prescribers

Documentation Required

Verify pharmacy Medicare Part B billing and transfer prescription if needed

Inform the current pharmacy that the recipient has Medicare Part B and ask whether the pharmacy can bill Medicare Part B for diabetic supplies; if the pharmacy can bill Medicare, confirm any additional paperwork or steps required. If the pharmacy cannot bill Medicare Part B, transfer the prescription to a Medicare-enrolled pharmacy or supplier that can bill Part B.

Ask the pharmacy if they can bill Medicare Part B for diabetic supplies.
Request details on any additional paperwork or steps needed for Medicare billing.
If unable to bill Medicare Part B, arrange transfer of the prescription to a Medicare-enrolled pharmacy or supplier.

Note

Locate and confirm a Medicare-enrolled pharmacy or supplier

Use Medicare.gov to locate a Medicare-enrolled pharmacy or supplier, review the available options, and then contact the chosen pharmacy or supplier to confirm they are accepting new clients and can provide diabetic testing supplies billed to Medicare Part B.

Follow the Medicare.gov directions to find Medicare-enrolled pharmacies or suppliers.
Contact selected provider to confirm they accept new clients and can provide diabetic supplies.
Ask the provider about their process for transferring prescriptions to them.

Documentation Required

Tell prescriber to update and send prescription to Medicare-enrolled supplier

Notify the prescriber that the recipient needs supplies billed to Medicare Part B and request the prescriber update and send the prescription to the Medicare-enrolled pharmacy or supplier.

Ask the prescriber to update the prescription as needed for the new Medicare-enrolled pharmacy or supplier.
Provide the prescriber's office with the contact information for the new pharmacy or supplier and any Medicare billing questions.

Key definitions and payer principles

Payer of last resort (Medicaid billing order)

DefinitionMedicaid is the payer of last resort: if a recipient has other coverage (including Medicare), that coverage must be billed before Medicaid.

ConsequenceIf a pharmacy does not submit claims to Medicare Part B before billing Medicaid, the Medicaid claims will be denied.

Required action for pharmaciesBill Medicare Part B first for diabetic supplies for dually eligible recipients; if unable, the recipient must transfer the prescription to a Medicare-enrolled pharmacy or supplier.

ScopeApplies to Alaska Medicaid recipients who also have Medicare; state and federal law require this billing order.

Medicare benefit required to be billed first

Required Medicare benefitMedicare Part B must be billed first for diabetic testing supplies for recipients eligible for both Medicare and Alaska Medicaid.

Implication for pharmaciesThe pharmacy providing supplies must be Medicare-enrolled and able to bill Medicare Part B; otherwise Medicaid will not pay.

Recipient actionWork with your pharmacy and prescriber to ensure supplies are ordered from a pharmacy or supplier enrolled to bill Medicare Part B to avoid denials or out-of-pocket costs.

OpenPayer

Immediate Action Needed to Ensure Access to Diabetic Supplies

Billing rules for diabetic testing supplies

Billing requirement and code guidance

Actions for pharmacies, suppliers, and prescribers

Key definitions and payer principles