Diabetic supplies coverage for Medicare Advantage plans
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This document lists covered diabetic supplies (glucose meters, test strips, CGMs, insulin delivery devices, and related supplies) for Aspirus Health Plan Medicare Advantage members and indicates benefit part, acquisition channel, quantity limits, and prior authorization requirements.
No material clinical or coverage changes in this revision.
Covered Diabetic Supplies and Devices
Glucose meters and test strips
Covered when the specific product and acquisition channel match the listed benefit part and quantity guidance:
Continuous Glucose Monitors
Covered with criteria and prior authorization where noted:
ALL of the following
- Requires prior authorization
- Benefit Covered Under = Part B
- Can obtain through pharmacy or Aspirus Health Plan contracted DME provider
- Quantity limit: See formulary for QL
ALL of the following
- Requires prior authorization
- Benefit Covered Under = Part B
- Can obtain through pharmacy or Aspirus Health Plan contracted DME provider
- Quantity limit: See formulary for QL
Insulin delivery devices
Insulin delivery devices coverage and acquisition rules:
ALL of the following
- Requires prior authorization
- Benefit Covered Under = Part D
- Can obtain through pharmacy
- Quantity limit: See formulary for QL
ALL of the following
- Covered under Part B
- Can obtain through Aspirus Health Plan contracted DME provider
- Quantity limit: No QL
Ancillary supplies
Ancillary supplies are covered as indicated by product category:
ALL of the following
- Benefit Covered Under = Part B
- Can obtain through pharmacy or Aspirus Health Plan contracted DME provider
- Quantity limit: No QL
ALL of the following
- Benefit Covered Under = Part D
- Can obtain through pharmacy or Aspirus Health Plan contracted DME provider
- Quantity limit: No QL
ALL of the following
- Benefit Covered Under = Part D
- Can obtain through pharmacy
- Quantity limit: No QL
Coding, DME Keys, and Quantity Limits
| No codes listed |
Prior Authorization and Provider Requirements
Prior authorization required for Dexcom, Freestyle Libre, and Omnipod (including cartridges)
Dexcom continuous glucose monitors, Freestyle Libre continuous glucose monitors, and Omnipod devices (including Omnipod cartridges) require prior authorization before coverage is provided.
- Dexcom — “requires prior authorization” (Benefit Covered Under = Part B)
- Freestyle Libre — “requires prior authorization” (Benefit Covered Under = Part B)
- Omnipod and Omnipod cartridges — “requires prior authorization” (Benefit Covered Under = Part D)
Benefit Placement and Acquisition Channels
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