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Preferred Diabetic Supply List (PDSL)

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•  Preferred Diabetic Supply List (PDSL) 

Preferred Diabetic Supply List (PDSL)

Blood Glucose Monitor	Corresponding Test Strip	Manufacturer	Customer Assistance
FreeStyle Freedom Lite System Kit	FreeStyle Lite Test Strips	Abbott Diabetes Care	1-888-522-5226
FreeStyle Lite System Kit	FreeStyle Lite Test Strips	Abbott Diabetes Care	1-888-522-5226
FreeStyle InsuLinx Meter	FreeStyle InsuLinx Test Strips	Abbott Diabetes Care	1-888-522-5226
Precision Xtra Meter	Precision Xtra Test Strips	Abbott Diabetes Care	1-888-522-5226
Accu-chek Aviva Care Kit	Accu-chek Aviva and Accu-chek Aviva Plus Test Strips	Roche Diagnostics	1-888-803-8934
Accu-chek Nano Smartview Meter	Accu-chek Smartview Test Strips	Roche Diagnostics	1-888-803-8934

Bulletins

The following bulletins contain information about the implementation of the Preferred Diabetic Supply List (PDSL).

• BR201052 - For DME and pharmacy providers, and prescribers
• BT201055 - For DME and pharmacy providers, and prescribers
• BT201047 - For prescribers

Member Notice

Information about the PDSL is published in the member section of indianamedicaid.com.

Frequently Asked Questions about Blood Glucose Monitors and Diabetic Test Strips

Why did the Indiana Health Coverage Programs (IHCP) create the Preferred Diabetic Supply List (PDSL)?

The IHCP created the PDSL to ensure that IHCP members receive the highest quality products at the lowest cost to the Indiana Medicaid program. Due to rebates, the net cost to the Indiana Medicaid program for the blood glucose monitors and diabetic test strips listed on the PDSL is lower than the cost of blood glucose monitors and diabetic test strips not listed on the PDSL.

Does the PDSL affect all diabetic testing supplies?

The PDSL applies only to blood glucose monitors and diabetic test strips. There are no changes to any other diabetic testing supplies at this time.

Do the PDSL and the new billing requirements apply to third-party liability (TPL) claims?

If a member has TPL, and the blood glucose monitor or diabetic test strips are covered by the other payer, members do not have to use a product on the PDSL, but the provider is required to submit the appropriate National Drug Code (NDC) and procedure code combination. If the other payer does not cover blood glucose monitors or diabetic test strips, the member must use a product on the PDSL, and the provider is required to submit the appropriate NDC and procedure code combination. If the member is unable to use the products on the PDSL due to a medical reason, a prior authorization (PA) must be requested for the products not listed on the PDSL.

Do the PDSL and the new billing requirements apply to claims for dually eligible members (members with Medicare)?

Dually eligible members are not required to use the products on the PDSL, but the provider is required to submit the appropriate NDC and procedure code combination.

If a member already has an approved PA on file for the quantity limits on diabetic test strips, does the member need another PA for a product not on the PDSL?

The IHCP honors existing PAs from quantity limits through the end of the prior authorized period for diabetic test strips on the PDSL. Diabetic test strips not on the PDSL require PA for both the quantity limit and coverage. Prescribers are encouraged to prescribe for the products on the PDSL to eliminate the need for PA.

Which PA form should providers use for blood glucose monitors and diabetic test strips?

Use the Indiana Health Coverage Programs Prior Authorization Form on indianamedicaid.com under Forms > Prior Authorization > Universal Prior Authorization Request Form - MCEs.

Should members begin transitioning to the products on the PDSL immediately?

Members may begin transitioning to the preferred products immediately.  The PDSL and billing requirements affecting blood glucose monitors and diabetic test strips become effective January 1, 2011. Providers will use the PDSL and the new billing requirements for blood glucose monitors and diabetic test strips for claims with dates of service on and after January 1, 2011.

If a member recently received a new meter that is not on the PDSL, is the provider able to bill for another meter that is on the PDSL?

The provider can dispense and bill for a meter on the PDSL regardless of when the member received his or her current meter.

What should the pharmacy do if it receives a rejection message saying that the fill is too soon or that plan limitations have been exceeded?

The IHCP does not deny durable medical equipment (DME) claims for early refill, and there are no limitation audits on blood glucose monitors. If providers receive these rejections immediately after submitting the claim, they should contact their third-party help desk or clearinghouse.

What National Drug Codes (NDCs) are on the Preferred Diabetic Supply List?

Both retail and nonretail NDCs are included on the Preferred Diabetic Supply List for the listed products. Providers can contact Abbott Diabetes Care Product Support Line, 1-888-522-5226, or Roche Diagnostics Customer Care Center, 1-888-803-8934, for a comprehensive list of each manufacturer's NDCs that are included on the Preferred Diabetic Supply List.

Does this affect the Indiana Medicaid reimbursement rate on these products and procedure codes?

The IHCP is not changing its reimbursement policy pertaining to blood glucose monitors or diabetic test strips at this time. Claims for these products continue to be priced according to the Fee Schedule available on indianamedicaid.com.