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    v1.0.28
    OpenPayerPolicy UpdatesEndocrinologyCigna Diabetic Supplies Prior Auth | OpenPayer
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    ModifiedCignaPolicy IP0272

    Diabetic Supplies

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    This policy governs prior authorization and medical-necessity criteria for diabetes-related supplies, including glucose meters, test strips, lancets, lancing devices, pen needles, and syringes. Criteria differ between employer plans and individual and family plans, with non-formulary products generally requiring trial of formulary alternatives or documented compatibility, functional, or product-specific needs.

    Policy Summary
    PayerCigna
    PolicyDiabetic Supplies
    Policy CodePolicy IP0272
    Change TypeModified
    Effective DateOct 15, 2026
    Last ReviewSep 17, 2026
    Next Review DateNot specified
    Key ActionPrior authorization is required for benefit coverage of diabetes-related diabetic supplies.
    SourceLink
    POLICY UPDATE CHANGES

    Preferred-product criteria were revised to reduce the required step-through from two preferred products to one and to add options for use with a non-compatible insulin pump or meter system and for patients using a FreeStyle Libre reader.

    Accu-Chek and Accutrend were added as preferred alternatives.

    Glucose test strips, lancets, glucose meters, lancing devices, and related plan-specific non-formulary classes were added or expanded in the policy.

    FreeStyle and TRUE METRIX test strips were added to preferred alternatives.

    OneTouch test strips, OneTouch lancets, and the OneTouch lancing device were removed from the identified preferred alternatives.

    FreeStyle and TRUEplus lancets and the TRUEdraw lancing device were added as preferred alternatives.

    The criterion for FreeStyle Precision strips used with a FreeStyle Libre reader was removed.

    Multiple named products were directed to existing non-formulary criteria, including Simpli pen needles, Easy Comfort and Safety Lancets, Contour Next One meters, TopFine and Autokeeper Safety pen needles, Mobi test strips and lancing devices, and Smart Bluetooth glucose monitors.

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    RequiredUtilization-management requirement
    2Plan categories
    5Employer-plan glucose-strip alternatives
    3Individual-plan meter alternatives
    1Preferred-product step-through

    Plan-Specific Medical Necessity Criteria

    Employer Plans — Glucose Test Strips (Non-Formulary)

    Employer-plan glucose test strips (non-formulary) are considered medically necessary when ONE of the following is met.

    ONE of

    • Patient has tried ONE of the following

      • Accu-Chek Test Strips
      • Accutrend Test Strips
      • FreeStyle Test Strips
      • TRUE METRIX Test Strips
      • Precision XTRA Test Strips
    • Patient is using an insulin pump/meter system that is not compatible with one of the available formulary alternatives

    • For Standard/Performance/Value/Advantage/Total Savings plans, patient has tried ONE of the following

      • FreeStyle Test Strips
      • TRUE METRIX Test Strips
      • Precision XTRA Test Strips
    • For Standard/Performance/Legacy/Value/Advantage/Total Savings plans, patient is using an insulin pump/meter system that is not compatible with one of the available formulary alternatives

    Employer Plans — Pen Needles (Non-Formulary)

    Employer-plan pen needles (non-formulary) are considered medically necessary when ONE of the following is met.

    ONE of

    • Patient has tried BD/Embecta Pen Needles
    • Patient requires a needle of the requested length and/or gauge which is not available as a BD/Embecta pen needle product

    Employer Plans — Syringes (Non-Formulary)

    Employer-plan syringes (non-formulary) are considered medically necessary when ONE of the following is met.

    ONE of

    • Patient has tried BD/Embecta Syringes
    • Patient requires a syringe of the requested length, volume and/or gauge which is not available as a BD/Embecta syringe product

    Individual and Family Plans — Glucose Meters (Non-Formulary)

    Individual and Family plan glucose meters (non-formulary) are considered medically necessary when ONE of the following is met.

    ONE of

    • Patient has tried ONE of the following

      • FreeStyle Glucose Meter
      • TRUE METRIX Glucose Meter
      • Precision XTRA Glucose Meter
    • Patient is using an insulin pump/meter system that is not compatible with one of the available formulary alternatives
    • Patient is blind or significantly visually impaired and is requesting a meter with audio capabilities

    Individual and Family Plans — Glucose Test Strips (Non-Formulary)

    Individual and Family plan glucose test strips (non-formulary) are considered medically necessary when ONE of the following is met.

    ONE of

    • Patient has tried ONE of the following

      • FreeStyle Test Strips
      • TRUE METRIX Test Strips
      • Precision XTRA Test Strips
    • Patient is using an insulin pump/meter system that is not compatible with one of the available formulary alternatives

    Individual and Family Plans — Lancets (Non-Formulary)

    Individual and Family plan lancets (non-formulary) are considered medically necessary when ONE of the following is met.

    ONE of

    • Patient has tried ONE of the following

      • FreeStyle Lancets
      • TRUEplus Lancets
    • Patient was unable to adhere to a regimen using standard insulin products

    Individual and Family Plans — Lancing Devices (Non-Formulary)

    Individual and Family plan lancing devices (non-formulary) are considered medically necessary when ONE of the following is met.

    ONE of

    • Patient has tried TRUEdraw lancing device
    • Patient was unable to adhere to a regimen using standard insulin products

    Authorization, Documentation, and Exception Requirements

    Prior Authorization

    Obtain prior authorization

    Prior authorization is required for benefit coverage of diabetes-related diabetic supplies.

    Step Therapy

    Complete glucose-strip step therapy

    For employer-plan non-formulary glucose test strips, document that the patient has tried one listed formulary alternative, unless the patient’s insulin pump/meter system is not compatible with an available formulary alternative.

    • Accu-Chek Test Strips
    • Accutrend Test Strips
    • FreeStyle Test Strips
    • TRUE METRIX Test Strips
    • Precision XTRA Test Strips

    Supply and Device Considerations

    Blood glucose meters differ in sample size, ability to test at alternate sites beyond the fingertips, screen readability, and availability of speaking or audio functions. A limited number also communicate wirelessly with a specific insulin pump to provide glucose data supporting basal and bolus insulin needs. These compatibility and functional features may be relevant when evaluating a requested meter or related supply.

    Test strips are evaluated under applicable International Organization for Standardization and/or FDA accuracy standards; however, accuracy may vary among monitoring systems. The ADA Standards of Care do not prefer one particular test-strip brand over another.

    Policy Summary
    PayerCigna
    PolicyDiabetic Supplies
    Policy CodePolicy IP0272
    Change TypeModified
    Effective DateOct 15, 2026
    Last ReviewSep 17, 2026
    Next Review DateNot specified
    Key ActionPrior authorization is required for benefit coverage of diabetes-related diabetic supplies.
    SourceLink
    On This Page
    Plan-Specific Medical Necessity CriteriaAuthorization, Documentation, and Exception RequirementsSupply and Device Considerations

    Meters with audio capabilities include Advocate (Redi-Code plus speaking meter); Arkray (Glucocard Expression, Glucocard Shine Express); Foracare (Fora D40D, Fora D40G, Fora Gtel, Fora Premium V10 BLE, Fora Test N' Go Advance Voice, Fora Tn'G Voice, Fora V30); Oak Tree Health (EasyMax V, Fortiscare V3); Omnis Health; Embrace Talk; Prodigy (Prodigy Autocode, Prodigy Voice); and Relion Premier Voice.

    Step Therapy

    Complete pen-needle step therapy

    For employer-plan non-formulary pen needles, document a prior trial of BD/Embecta Pen Needles, unless the requested needle length and/or gauge is unavailable as a BD/Embecta pen needle product.

    • Required trial: BD/Embecta Pen Needles
    • Exception: requested length and/or gauge is unavailable from BD/Embecta
    Step Therapy

    Complete syringe step therapy

    For employer-plan non-formulary syringes, document a prior trial of BD/Embecta Syringes, unless the requested syringe length, volume, and/or gauge is unavailable as a BD/Embecta syringe product.

    • Required trial: BD/Embecta Syringes
    • Exception: requested length, volume, and/or gauge is unavailable from BD/Embecta
    Step Therapy

    Complete meter step therapy

    For individual and family plan non-formulary glucose meters, document that the patient has tried one listed formulary meter, unless the insulin pump/meter system is incompatible with an available formulary alternative or the patient is blind or significantly visually impaired and requires audio capabilities.

    • FreeStyle Glucose Meter
    • TRUE METRIX Glucose Meter
    • Precision XTRA Glucose Meter
    Step Therapy

    Complete glucose-strip step therapy

    For individual and family plan non-formulary glucose test strips, document that the patient has tried one listed formulary alternative, unless the patient’s insulin pump/meter system is not compatible with an available formulary alternative.

    • FreeStyle Test Strips
    • TRUE METRIX Test Strips
    • Precision XTRA Test Strips
    Step Therapy

    Complete lancet step therapy

    For individual and family plan non-formulary lancets, document that the patient has tried FreeStyle Lancets or TRUEplus Lancets, or document that the patient was unable to adhere to a regimen using standard products.

    • Required trial: FreeStyle Lancets or TRUEplus Lancets
    • Exception: inability to adhere to a regimen using standard products
    Step Therapy

    Complete lancing-device step therapy

    For individual and family plan non-formulary lancing devices, document a trial of the TRUEdraw lancing device or document that the patient was unable to adhere to a regimen using the product or regimen described in the policy.

    • Required trial: TRUEdraw lancing device
    • Exception: inability to adhere to the applicable product or regimen
    Documentation Required

    Document the formulary exception rationale

    Document the requested supply, the applicable plan category, any required trial of formulary alternatives, and the specific reason the alternative was unsuccessful or unsuitable. For pump or meter-system exceptions, document incompatibility with available formulary alternatives; for audio-capable meters, document blindness or significant visual impairment.

    • Requested supply and plan category
    • Required formulary trial, if applicable
    • Specific reason the alternative was unsuccessful or unsuitable
    • Incompatibility, blindness, or significant visual impairment documentation when applicable
    Documentation Required

    Document needle or syringe requirements

    For non-formulary pen needles and syringes, document either the prior BD/Embecta trial or the required needle or syringe specifications that are unavailable from BD/Embecta.

    • Pen needles: required length and/or gauge
    • Syringes: required length, volume, and/or gauge
    • Prior BD/Embecta trial or documented product-specific exception
    Billing Rule

    Use covered diagnoses and codes

    Claims may be denied when the service is billed for a condition or diagnosis not covered under the policy or when the submission is not accompanied by applicable covered code(s). Use the most appropriate codes as of the effective date of submission.

    • Bill only for covered conditions or diagnoses
    • Submit applicable covered code(s)
    • Use the most appropriate codes as of the submission date
    Denial Risk

    Meet non-formulary exception criteria

    Non-formulary diabetic supplies may be denied when the required formulary trial or an applicable exception is not documented. This includes insulin-pump or meter-system incompatibility, visual-impairment needs for audio-capable meters, inability to adhere to a standard regimen, or product-specific fit requirements.

    • Required formulary trial is missing
    • Pump or meter-system incompatibility is not documented
    • Blindness or significant visual impairment is not documented when requesting audio capabilities
    • Inability to adhere to a standard regimen is not documented
    • Required length, volume, and/or gauge is not documented as unavailable from BD/Embecta