CurrentsimplyhealthcarePolicy N/A

Preferred diabetic supplies (meters, strips, lancets, pen needles)

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Defines Simply Healthcare Plans and Clear Health Alliance preferred diabetic meters, test strips, lancets, and pen needles for Florida Medicaid and Florida Healthy Kids members and describes quantity limits, prior authorization requirements, and how to obtain preferred products.

Policy Summary

Payersimplyhealthcare

PolicyPreferred diabetic supplies (meters, strips, lancets, pen needles)

Policy CodePolicy N/A

Change TypeRoutine review - no material changes

Effective DateN/A

Next Review DateN/A

Key ActionObtain prior authorization for nonpreferred products or quantities exceeding listed limits.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1/12mometer limit

200/30dstrips ≤17

150/30dstrips pregnant/insulin

50/30dstrips others

200/30dlancets insulin/pregnant/≤17

100/30dlancets others

Coverage Criteria and Rules

Coverage criteria and rules

Preferred items are covered; nonpreferred items require prior authorization. Quantity limits apply as specified below.

Preferred products should be prescribed and obtained when possible. TRUE METRIX AIR Meter and TRUE METRIX glucose testing strips are the preferred meter and strips for Simply and CHA.

ALL of the following

Preferred meter: TRUE METRIX AIR Meter
Preferred strips: TRUE METRIX glucose testing strips
Preferred pen needles: BD pen needle products (BD PEN NEEDLE MICRO ULTRAFINE; BD PEN NEEDLE MINI ULTRAFINE; BD PEN NEEDLE NANO 2ND GEN; BD PEN NEEDLE NANO ULTRAFINE; BD PEN NEEDLE ORIGINAL ULTRAFINE; BD PEN NEEDLE SHORT ULTRAFINE; BD AUTOSHIELD; BD AUTOSHIELD DUO)
Preferred lancets: CVS and TRUEPLUS lancet products (CVS LANCETS THIN 26G; CVS LANCETS ULTRA THIN 30; CVS LANCETS MICRO THIN 33; TRUEPLUS LANCETS 26G; TRUEPLUS LANCETS variants as listed)

ALL of the following

Quantity limits - meter: Blood glucose testing meter: 1 meter per 12 months.
Quantity limits - strips for members ≤17: Blood glucose testing strips: 200 (or 204 for Accu-Check Compact) per 30 days for members 17 years of age and younger.
Quantity limits - strips for pregnant or 18+ on insulin: Blood glucose testing strips: 150 (or 153 for Accu-Check Compact) per 30 days for pregnant members or members 18 years of age or older utilizing insulin.
Quantity limits - strips for others: Blood glucose testing strips: 50 (or 51 for Accu-Check Compact) per 30 days for all other individuals.
Quantity limits - lancets for insulin/pregnant/≤17: Lancets: 200 lancets per 30 days for members utilizing insulin, pregnant members, or members 17 years of age or younger.
Quantity limits - lancets for others: Lancets: 100 lancets per 30 days for all other individuals.
Quantity limits - pen needles: Pen needles: 200 pen needles per 30 days.

Prior authorization (PA) is required for coverage of nonpreferred products and for quantities exceeding the limits listed above.

Preferred products may be filled at any participating in‑network pharmacy; providers should provide a prescription for a preferred product.

Coding, Quantities, and Limits

Preferred NDCs and claim submission dataNDCCovered

56151-1490-02	TRUE METRIX AIR Meter NDC (per bulletin)
56151-1460-04	TRUE METRIX Strips NDC 50 count (per bulletin)
56151-1460-01	TRUE METRIX Strips NDC 100 count (per bulletin)

Meter quantity limit

Meter quantity limit1 meter per 12 months

ApplicabilityApplies to Simply Healthcare Plans and Clear Health Alliance Medicaid and Florida Healthy Kids members

Prior authorizationPA required for nonpreferred meters and quantities exceeding the limit

Strips — members 17 and younger

Strips limit (members ≤17)200 strips per 30 days (204 strips per 30 days for Accu‑Check Compact)

Preferred stripsTRUE METRIX glucose testing strips

Prior authorizationPA required for nonpreferred strips or quantities exceeding limits

Strips — pregnant or adults on insulin

Strips limit (pregnant or ≥18 on insulin)150 strips per 30 days (153 strips per 30 days for Accu‑Check Compact)

Applies toPregnant members or members 18 years or older using insulin

Preferred stripsTRUE METRIX glucose testing strips

Strips — other individuals

Strips limit (all other individuals)50 strips per 30 days (51 strips per 30 days for Accu‑Check Compact)

Applies toMembers not meeting criteria for higher limits (not pregnant and not using insulin)

Preferred stripsTRUE METRIX glucose testing strips

Lancets — insulin users, pregnant, or ≤17

Lancets limit (insulin users, pregnant, or ≤17)200 lancets per 30 days

Applies toMembers utilizing insulin, pregnant members, or members 17 years of age or younger

Preferred lancets examplesCVS LANCETS THIN 26G; TRUEPLUS lancets listed in bulletin

Lancets — other individuals

Lancets limit (all other individuals)100 lancets per 30 days

Applies toMembers not using insulin and not pregnant and older than 17

Preferred lancets examplesCVS LANCETS ULTRA THIN 30; CVS LANCETS MICRO THIN 33

Pen needles quantity limit

Pen needles quantity limit200 pen needles per 30 days

Preferred pen needlesBD PEN NEEDLE MICRO ULTRAFINE; BD PEN NEEDLE MINI ULTRAFINE (per bulletin)

Prior authorizationPA required for nonpreferred pen needles or quantities exceeding limits

Provider Actions and Prior Authorization

Prior Authorization

Prior authorization required for nonpreferred products and excess quantities

Prior authorization (PA) is required for coverage of nonpreferred diabetic meters and strips and for quantities that exceed the limits listed in this bulletin (for example, more than 1 meter per 12 months or strip/lancet/pen‑needle quantities above the per‑30‑day limits).

Documentation Required

How to obtain the preferred TRUE METRIX AIR Meter

To obtain the preferred TRUE METRIX AIR Meter, members may call 1-866-788-9618 to have a meter shipped directly to their home free of charge, or they may take a prescription for the TRUE METRIX AIR Meter to an in‑network pharmacy; pharmacies must submit claims using NDC 56151-1490-02 and the specified BIN/PCN/ID/Rx group.

Phone: 1-866-788-9618 — meter can be shipped to member’s home at no charge (per bulletin).
In‑network pharmacy option — pharmacy must use NDC 56151-1490-02 and BIN 015251, PCN PRX2000, ID HB224289455, Rx group TRUEPORT22 when submitting claims.

Definitions

Preferred products

Preferred products definitionPreferred diabetic meters, strips, lancets, and pen needles identified by Simply and CHA (e.g., TRUE METRIX AIR Meter and TRUE METRIX Strips)

Examples — meter and stripsTRUE METRIX AIR Meter; TRUE METRIX glucose testing strips

Coverage notePreferred products should be prescribed and obtained when possible; nonpreferred items require PA

Prior authorization

Prior authorization requirementPA is required for coverage of nonpreferred diabetic meters and strips and for quantities exceeding the listed limits

Provider actionProvide prescription for preferred product to be filled at participating in‑network pharmacy or follow PA process for nonpreferred items

ApplicabilityApplies to Simply Healthcare Plans and Clear Health Alliance Medicaid and Florida Healthy Kids members

Policy Summary

Payersimplyhealthcare

PolicyPreferred diabetic supplies (meters, strips, lancets, pen needles)

Policy CodePolicy N/A

Change TypeRoutine review - no material changes

Effective DateN/A

Next Review DateN/A

Key ActionObtain prior authorization for nonpreferred products or quantities exceeding listed limits.

SourceLink

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Preferred diabetic supplies (meters, strips, lancets, pen needles)

Customize your policy alerts

Sign up for all simplyhealthcare policy alerts

Know when simplyhealthcare releases new policies or updates existing guidance.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Coverage Criteria and Rules

Coverage criteria and rules

Preferred items are covered; nonpreferred items require prior authorization. Quantity limits apply as specified below.

Preferred products should be prescribed and obtained when possible. TRUE METRIX AIR Meter and TRUE METRIX glucose testing strips are the preferred meter and strips for Simply and CHA.

ALL of the following

Preferred meter: TRUE METRIX AIR Meter
Preferred strips: TRUE METRIX glucose testing strips
Preferred pen needles: BD pen needle products (BD PEN NEEDLE MICRO ULTRAFINE; BD PEN NEEDLE MINI ULTRAFINE; BD PEN NEEDLE NANO 2ND GEN; BD PEN NEEDLE NANO ULTRAFINE; BD PEN NEEDLE ORIGINAL ULTRAFINE; BD PEN NEEDLE SHORT ULTRAFINE; BD AUTOSHIELD; BD AUTOSHIELD DUO)
Preferred lancets: CVS and TRUEPLUS lancet products (CVS LANCETS THIN 26G; CVS LANCETS ULTRA THIN 30; CVS LANCETS MICRO THIN 33; TRUEPLUS LANCETS 26G; TRUEPLUS LANCETS variants as listed)

ALL of the following

Quantity limits - meter: Blood glucose testing meter: 1 meter per 12 months.
Quantity limits - strips for members ≤17: Blood glucose testing strips: 200 (or 204 for Accu-Check Compact) per 30 days for members 17 years of age and younger.
Quantity limits - strips for pregnant or 18+ on insulin: Blood glucose testing strips: 150 (or 153 for Accu-Check Compact) per 30 days for pregnant members or members 18 years of age or older utilizing insulin.
Quantity limits - strips for others: Blood glucose testing strips: 50 (or 51 for Accu-Check Compact) per 30 days for all other individuals.
Quantity limits - lancets for insulin/pregnant/≤17: Lancets: 200 lancets per 30 days for members utilizing insulin, pregnant members, or members 17 years of age or younger.
Quantity limits - lancets for others: Lancets: 100 lancets per 30 days for all other individuals.
Quantity limits - pen needles: Pen needles: 200 pen needles per 30 days.

Prior authorization (PA) is required for coverage of nonpreferred products and for quantities exceeding the limits listed above.

Preferred products may be filled at any participating in‑network pharmacy; providers should provide a prescription for a preferred product.

Coding, Quantities, and Limits

Preferred NDCs and claim submission dataNDCCovered

56151-1490-02	TRUE METRIX AIR Meter NDC (per bulletin)
56151-1460-04	TRUE METRIX Strips NDC 50 count (per bulletin)
56151-1460-01	TRUE METRIX Strips NDC 100 count (per bulletin)

Meter quantity limit

Meter quantity limit1 meter per 12 months

ApplicabilityApplies to Simply Healthcare Plans and Clear Health Alliance Medicaid and Florida Healthy Kids members

Prior authorizationPA required for nonpreferred meters and quantities exceeding the limit

Strips — members 17 and younger

Strips limit (members ≤17)200 strips per 30 days (204 strips per 30 days for Accu‑Check Compact)

Preferred stripsTRUE METRIX glucose testing strips

Prior authorizationPA required for nonpreferred strips or quantities exceeding limits

Strips — pregnant or adults on insulin

Strips limit (pregnant or ≥18 on insulin)150 strips per 30 days (153 strips per 30 days for Accu‑Check Compact)

Applies toPregnant members or members 18 years or older using insulin

Preferred stripsTRUE METRIX glucose testing strips

Strips — other individuals

Strips limit (all other individuals)50 strips per 30 days (51 strips per 30 days for Accu‑Check Compact)

Applies toMembers not meeting criteria for higher limits (not pregnant and not using insulin)

Preferred stripsTRUE METRIX glucose testing strips

Lancets — insulin users, pregnant, or ≤17

Lancets limit (insulin users, pregnant, or ≤17)200 lancets per 30 days

Applies toMembers utilizing insulin, pregnant members, or members 17 years of age or younger

Preferred lancets examplesCVS LANCETS THIN 26G; TRUEPLUS lancets listed in bulletin

Lancets — other individuals

Lancets limit (all other individuals)100 lancets per 30 days

Applies toMembers not using insulin and not pregnant and older than 17

Preferred lancets examplesCVS LANCETS ULTRA THIN 30; CVS LANCETS MICRO THIN 33

Pen needles quantity limit

Pen needles quantity limit200 pen needles per 30 days

Preferred pen needlesBD PEN NEEDLE MICRO ULTRAFINE; BD PEN NEEDLE MINI ULTRAFINE (per bulletin)

Prior authorizationPA required for nonpreferred pen needles or quantities exceeding limits

Provider Actions and Prior Authorization

Prior Authorization

Prior authorization required for nonpreferred products and excess quantities

Documentation Required

How to obtain the preferred TRUE METRIX AIR Meter

Phone: 1-866-788-9618 — meter can be shipped to member’s home at no charge (per bulletin).
In‑network pharmacy option — pharmacy must use NDC 56151-1490-02 and BIN 015251, PCN PRX2000, ID HB224289455, Rx group TRUEPORT22 when submitting claims.

Definitions

Preferred products

Preferred products definitionPreferred diabetic meters, strips, lancets, and pen needles identified by Simply and CHA (e.g., TRUE METRIX AIR Meter and TRUE METRIX Strips)

Examples — meter and stripsTRUE METRIX AIR Meter; TRUE METRIX glucose testing strips

Coverage notePreferred products should be prescribed and obtained when possible; nonpreferred items require PA

Prior authorization

Prior authorization requirementPA is required for coverage of nonpreferred diabetic meters and strips and for quantities exceeding the listed limits

Provider actionProvide prescription for preferred product to be filled at participating in‑network pharmacy or follow PA process for nonpreferred items

ApplicabilityApplies to Simply Healthcare Plans and Clear Health Alliance Medicaid and Florida Healthy Kids members