CurrentUnitedHealthcarePolicy N/A

Prior Authorization for Diabetic Blood Glucose Meters and Test Strips

Defines prior authorization criteria for non-preferred diabetic blood glucose meters and test strips and lists preferred products covered without prior authorization; applies to UnitedHealthcare pharmacy benefit populations.

Policy Summary

PayerUnitedHealthcare

PolicyPrior Authorization for Diabetic Blood Glucose Meters and Test Strips

Policy CodePolicy N/A

Change TypePreferred product list updatedcoverage clarified

Effective DateNov 1, 2025

Next Review DateN/A

Key ActionObtain and submit medical records documenting a physical or mental limitation that makes use of preferred meters/test strips unsafe, inaccurate, or not feasible to support prior authorization for non-preferred products.

SourceLink

POLICY UPDATE CHANGES

Updated preferred products to remove all Lifescan OneTouch products and add Contour Plus Blue.

Accu-Chek Guide, Accu-Chek Guide Me, Contour Next and Contour Plus Blue products are covered without prior authorization.

12 monthsauthorization duration

8/2025P&T approvals through

FL/ME/TN/TXstate callouts

Coverage Criteria

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Primary criteria: 1) Product is a non-preferred diabetic meter or test strip (products listed in program description) AND 2) Submission of medical records documents a physical or mental limitation that makes utilization of one of the listed preferred meters/test strips unsafe, inaccurate, or otherwise not feasible (e.g., manual dexterity).

Authorization issued for 12 months; state mandates and supply limitations may apply.

Products typically excluded from coverage are identified in the program rules; supply limitations may apply. UnitedHealthcare may apply supply limitations and some products are noted as "**Typically excluded from coverage." Additionally, a specific set of meters and test strips are listed as covered without prior authorization (see definitions/preferences), while other non-preferred products require prior authorization per the criteria.

Provider Actions and Requirements

Prior Authorization

Prior Authorization for Non-Preferred Meters/Test Strips

Prior authorization is required for non-preferred diabetic meters and test strips. Approvals are granted for up to 12 months when medical records document a physical or mental limitation (for example, impaired manual dexterity) that makes use of a listed preferred meter/test strip unsafe, inaccurate, or otherwise not feasible. UnitedHealthcare may also approve initial or re-authorization based on prior claim/medication history, diagnosis codes (ICD-10), and/or automated claim logic.

Approval duration: up to 12 months
Automated approvals may occur based on claims/diagnosis history

Step Therapy

Preferred Product (Step) Requirement

A preferred (step one) product list is implemented. Products on the preferred list (including specified Contour and Accu-Chek products noted in policy) are covered without prior authorization/non-formulary review. Non-preferred products require documentation showing that an approved preferred product is not suitable.

Preferred (step one) products are covered without prior authorization
Non-preferred products require documented clinical rationale or limitation preventing use of preferred products

Documentation Required

Documentation Requirement for Exception

Submit medical records documenting the physical or mental limitation that prevents safe or effective use of preferred meters/test strips (examples: manual dexterity impairment). Lack of submitted documentation demonstrating such a limitation may result in denial or failure to authorize non-preferred products.

Examples of accepted documentation: clinical notes, physical/occupational therapy assessments, functional limitation documentation
Common acceptable limitations: manual dexterity, vision impairment, cognitive impairment

Definitions and Preferred Products

Preferred products — meters and test strips

Accu-Chek Guide seriesAccu-Chek Guide Meter and Accu-Chek Guide Me Meter (Accu-Chek Guide Test Strips) are listed as preferred and covered without prior authorization.

Contour Next seriesContour Next Meter, Contour Next One Meter, Contour Next EZ Meter, and Contour Next Gen Meter (Contour Next Test Strips) are listed as preferred and covered without prior authorization.

Contour Plus BlueContour Plus Blue Meter (Contour Plus Test Strips) is listed as preferred and covered without prior authorization.

Coverage rationalePreferred meters/test strips are covered without prior authorization; non-preferred products require medical-record documentation of a physical or mental limitation making preferred products unsafe, inaccurate, or not feasible.

Initial Therapy Criteria

Initial authorization criteria

Initial authorization: Non-preferred meters/test strips will be approved when medical records document a physical or mental limitation that makes use of the listed preferred meters/test strips unsafe, inaccurate, or not feasible.

Approval period = 12 months; UnitedHealthcare may approve based on previous claim/medication history, diagnosis codes (ICD-10) and/or claim logic per program rules.

Continuation / Re-authorization Criteria

Re-authorization

Re-authorization: Authorization may be re-issued for 12 months; UnitedHealthcare may approve initial and re-authorization based solely on previous claim/medication history, diagnosis codes (ICD-10) and/or claim logic.

Use of automated approval/re-approval varies by program; state mandates may apply.

Step Therapy Requirements

Requirement	Details
Provider documentation required to bypass preferred (step) products	Provider must document the clinical reason that a preferred meter or test strip is unsafe, inaccurate, or not feasible for the member (e.g., medical records showing physical or mental limitation such as impaired manual dexterity).
Prior authorization and duration	Prior authorization is required for non-preferred diabetic meters and test strips; when medical records document inability to use preferred products, authorization is issued for 12 months.
Consequence of missing documentation	Lack of submitted medical records documenting the limitation may result in denial of coverage for non-preferred meters/test strips.
Preferred (step one) products — examples	Policy implements a preferred (step one) product list; preferred products (covered without prior authorization) include Accu‑Chek Guide products, Contour Next and Contour Plus Blue. The step one list was updated through P&T changes removing Lifescan OneTouch and adding Contour Plus Blue (changes through 8/2025).

Background

The American Diabetes Association recommends routine blood glucose monitoring for patients using insulin and notes monitoring may help guide treatment for selected patients on non-insulin therapies. UnitedHealthcare follows this clinical context and allows coverage for blood glucose meters and test strips according to program criteria: preferred meters and strips listed in the policy are covered without prior authorization, while non-preferred products may be approved only when documentation shows that the preferred products are unsafe, inaccurate, or not feasible for the member (for example, due to manual dexterity limitations).