CurrentHealth NetPolicy CP PMN.215

Non-Preferred Blood Glucose Monitors/Test Strips

Policy governs prior authorization and medical necessity criteria for non-preferred blood glucose monitors and test strips for Health Net (Medicaid) members; affects providers requesting coverage for non-preferred SMBG supplies. Continuous glucose monitors are covered under a different policy (CP.PMN.214).

Policy Summary

PayerHealth Net

PolicyNon-Preferred Blood Glucose Monitors/Test Strips

Policy CodePolicy CP PMN.215

Change TypeClarification and addition of quantity limit

Effective Date12.01.19

Next Review DateN/A

Key ActionSubmit prior authorization with supporting documentation (office notes, labs, or other clinical information) showing inability to use preferred monitors and that requested quantity does not exceed plan limits.

SourceLink

POLICY UPDATE CHANGES

Re-authorization is not permitted; members must meet the initial approval criteria for continued therapy.

Requirement that requested quantity does not exceed the health-plan quantity limit (if applicable).

12 monthsapproval duration

Medicaidline of business

CP.PMN.214related CGM policy

Multiplereviews 2020-2024

Coverage and Medical Necessity Criteria

Initial Approval Criteria

Covered when ALL of the following are met:

Initial Approval for Non-Preferred SMBG Monitors/Test Strips: 1) Documentation supports inability to use the health-plan preferred blood glucose monitor(s) and/or test strip(s). Examples include, but are not limited to: member has limited dexterity (e.g., arthritis) and requires larger test strips, a monitor with larger buttons, or a pre-loaded lancet drum with no individual lancets; member has impaired vision and requires a blood glucose monitor with audio; member is currently using an insulin pump that is incompatible with the preferred products.examples listed are non-exhaustive

Provider must supply supporting documentation (office notes, labs, or other clinical information).

Quantity Limit: 2) Requested quantity does not exceed the health-plan quantity limit (if applicable).as defined by health-plan limits

Approval duration: 12 months.

Policy Summary

PayerHealth Net

PolicyNon-Preferred Blood Glucose Monitors/Test Strips

Policy CodePolicy CP PMN.215

Change TypeClarification and addition of quantity limit

Effective Date12.01.19

Next Review DateN/A

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

What Providers Must Do

Prior Authorization

Prior Authorization Required

Prior authorization is required for non-preferred blood glucose monitors and test strips. Continuous glucose monitors (CGMs) are handled under a separate policy (CP.PMN.214).

Non-preferred blood glucose monitors and test strips — prior authorization required
Continuous glucose monitors (CGMs) — refer to CP.PMN.214

Note

Preferred Alternatives

Preferred alternative products are listed in Appendix B and may be required as therapeutic alternatives. Providers should consider these products when prescribing to avoid delays or denials.

See Appendix B: Therapeutic Alternatives (preferred monitors/test strips such as FreeStyle and Accu-Chek products)

Documentation Required

Required Documentation

Provider must submit documentation (office/chart notes, lab results, or other clinical information) supporting the member's need and that approval criteria are met.

Documentation must support inability to use preferred monitor/test strips (see triggers below)
Examples: office notes, lab results, device incompatibility documentation, vision/dexterity limitations

Denial Risk

Triggers for Denial

Requests may be denied if required documentation is not provided, if documentation does not demonstrate inability to use preferred products, or if requested quantities exceed health-plan limits.

Lack of documentation demonstrating inability to use preferred monitor/test strips
Requested quantity exceeds health-plan quantity limits
No evidence of device incompatibility with member's insulin pump when cited

OpenPayer

Non-Preferred Blood Glucose Monitors/Test Strips

Coverage and Medical Necessity Criteria

What Providers Must Do

Key Terms

Background and Scope