Q & A for Diabetic Supply Changes
Effective at 2010 Benefit Anniversary Dates
How will coverage for diabetic supplies change for 2010?
Effective with renewals on or after Jan. 1, 2010, coverage for diabetic supplies including syringes, lancets, lancet devices, pen devices, pen needles, insulin pump supplies, and blood test strips and solutions will move from the medical benefit to the prescription drug benefit. You will be required to have a prescription from your doctor in order for the pharmacy to submit your claims for these supplies under your prescription benefit. Contact your doctor about obtaining a prescription for your supplies. Be sure to present your Blue Cross and Blue Shield of Kansas (BCBSKS) identification card at the pharmacy.
When will the changes become effective?
These changes will become effective at the benefit anniversary date. If your benefit anniversary date is Jan. 1, 2010, the change is effective then. If your benefit anniversary date is July 1, 2010, the change will be effective July 1.
Why are these changes being made?
There is a limited number of contracting home medical equipment (HME) providers who supply diabetic supplies. Most diabetic supplies are purchased from pharmacies which contract for prescription drug benefits, but are not contracting for HME. Members currently have to submit their own claims for these items and reimbursement can be limited by non-contracting provider penalties. By having access to contracting pharmacies for these purchases, the member will only be responsible for their copayments, coinsurance or deductible amounts. Claims will need to be filed just like those for prescriptions drugs.
What diabetic supplies will be impacted?
Insulin syringes, lancets, lancet devices, insulin pen devices, pen needles used with pen devices, blood glucose test strips and solutions, blood glucose calibration strips and solutions, and supplies used with insulin pumps will move to coverage under the prescription benefit.
Will some diabetic related items continue to be covered under medical?
Yes. Blood glucose meters, insulin pumps and equipment and supplies used for continuous blood glucose monitoring (CGM) will continue to be covered under medical benefits.
Will this change impact all of our members?
This change will affect most of our members with prescription drug coverage from BCBSKS and members with prescription drug coverage from another carrier. Some self-insured groups may choose other coverage options.
What if the member does not have prescription drug coverage?
If the member does not have prescription drug coverage or if the member has prescription drug coverage from another carrier that does not include coverage for diabetic supplies, these supplies will continue to be covered under the member's medical benefit.
Will the member need a prescription for these items to be covered under their prescription benefits?
Yes. You will be required to have a prescription from your doctor in order for the pharmacy to submit your claims for these supplies under your prescription benefit. Contact your doctor about obtaining a prescription for your supplies. Be sure to present your BCBSKS identification card at the pharmacy.
What quantities may be purchased at one time?
If your prescription benefit requires you to pay the full allowed amount at the pharmacy and submit your own claims for reimbursement, you may purchase up to a 100 day supply. You should submit claims for diabetic supply items just like you submit claims for prescription drugs.
If you have a BlueRx Card benefit that requires you to only pay your copayment or coinsurance amount at the pharmacy, you may purchase the greater of a 34 day or 100 unit supply at one time. In some cases, the quantity dispensed may be limited to the available package size of the individual products.
Are diabetic supplies available from PrimeMail?
Yes. If your benefit includes a mail option, you may receive up to a 90 day supply of diabetic supplies from PrimeMail.
Can I continue to receive my supplies from a medical supply vendor?
Yes. Most medical supply vendors can submit claims for diabetic supplies in the electronic pharmacy claim format. You will need to tell your vendor that your supplies are now covered under your prescription benefit and you will need to provide them with the pharmacy claim submission information on your BCBSKS identification card. If your vendor can not submit claims electronically in the prescription claim format, you may continue to purchase your supplies from the vendor, but you will be required to submit your own claims and payment will be made to you.
Are there generic diabetic supplies?
Unlike prescription drugs, diabetic supplies are not available generically. However, if you have a BlueRx Card prescription benefit, insulin syringes and lancets will be available for a generic copayment. Other products, including pen devices, pen needles, insulin pump supplies, blood glucose test strips and solutions will be considered either formulary or non-formulary brands.
Will the formulary impact the coverage of diabetic supplies?
Yes. Formulary brand supplies will be listed on your Preferred Medication list. To reduce your out-of-pocket costs, consider using formulary brand blood glucose test strips. When changing strips, you will need to change meters. Your pharmacist may be able to supply you with a free Bayer (Contour® or Breeze®2) or Accu-Chek® blood glucose monitor. A free blood glucose monitor is also available by contacting either the Bayer or Accu-Chek® fulfillment center toll-free at 1-877-229-3777 (Bayer) or 1-888-355-4242 (Accu-Chek®).
Formulary Copay Brand Name
Non-Formulary Copay Brand Name
OneTouch® Ultra®, OneTouch® UltraSmart®, OneTouch® Ultra2®, OneTouch® UltraMiniTM, OneTouch® InDuo®, OneTouch® Basic®, OneTouch® SureStep®, OneTouch® FastTake®, OneTouch® Profile®