Diabetic Supplies Coverage as a Pharmacy Benefit (IB 23-11)
Date: 07/06/23
Louisiana Healthcare Connections is sharing with providers about changes to include reimbursement of continuous glucose monitors and other diabetic supplies as a pharmacy benefit starting October 1, 2023.
Effective with dates of service on or after December 1, 2023, the following diabetic supplies will be reimbursed as a pharmacy benefit only. Durable medical equipment (DME) claims will deny.
- Diabetes glucose meters
- Diabetic test strips
- Continuous glucose meters
- Transmitters and sensors
- External insulin pumps
- Control solution
- Ketone test strips
- Lancets and devices
- Pen needles
- Re-usable insulin pens
- Syringes
The procedure codes for the above diabetic supplies will no longer be located on the Louisiana Medicaid Durable Medical Equipment fee schedule. Provider manual updates will be completed to reflect these changes.
Preferred products and prior authorization criteria for continuous glucose monitors will be posted on the Single Preferred Drug List (PDL). Louisiana Healthcare Connections will no longer have our own diabetic supply preferred lists.
Reimbursement will be based on the lower of:
1. The wholesale acquisition cost (WAC) plus the professional dispensing fee; or
2. The provider’s usual and customary charge to the general public.
Diabetic test strips and lancets will continue to be subject to the current quantity limits.