On May 5, NYRx issued a notice NYRx Helpful Hints for Pharmacies: Diabetic Testing Supplies.
Diabetic Test Strips and Lancets: NYRx coverage of preferred blood glucose test strips and lancets for members with diabetes aligns with Medicare Coverage of Diabetes Supplies.
Pharmacies must submit claims based on units per days' supply as follows:
- Members who use insulin: Maximum 300 test strips and lancets per 90-day supply
- Members who do not use insulin: Maximum 100 test strips and lancets per 90-day supply
Continuous Glucose Monitors and Disposable Insulin Pumps: Continuous Glucose Monitors and Disposable Insulin Pumps should be billed at the pharmacy point-of-sale for the proper quantity and days' supply as outlined on the product label.
What Pharmacies Need to Do: The pharmacy should become familiar with the NYRx Preferred Diabetic Supply Program. When submitting claims for preferred diabetic supplies do not request a PA (prior authorization) from the prescriber if the claim rejection states one of the following:
- Maximum Quantity Exceeded
- Early Fill Overuse
- Recipient Ineligible on Service Date
- Refill Number Exceeds Maximum
- Therapeutic Duplication
- Client Has Medicare Part D or Client Has Other Insurance
- Coordination of Benefits Claim Processing
- NYRx is always the payor of last resort and federal regulations require that all other available resources be used before NYRx considers payment.
The NYRx Education & Outreach Call Center is available by phone at 1-833-967-7310 or by email at NYRxEO@primetherapeutics.com from 8:00 am to 5:00 pm ET, Monday through Friday, excluding holidays.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.