Author: CSRA
Beginning April 1, 2018, diabetic testing supplies will be transitioned to the North Carolina Medicaid and NC Health Choice Preferred Drug List (PDL) and Roche diabetic testing supplies will remain preferred. Pharmacy point-of-sale providers will no longer receive two separate payments for claims for Roche diabetic testing supplies. Instead, providers will receive one payment based on a State Maximum Allowable Cost (SMAC).
The following chart outlines the Roche diabetic testing supplies with their corresponding NDC number that will be preferred and their specific reimbursement amount and point-of-sale quantity limit:
|
Product |
NDC Number |
NC Medicaid SMAC Rate |
Point of Sale Limit |
|
ACCU-CHEK AVIVA PLUS 50 ct Test Strips |
65702-0407-10 |
$79.63/50 strips |
200/month |
|
ACCU-CHEK SMARTVIEW 50 ct Test Strips |
65702-0492-10 |
$79.63/50 strips |
200/month |
|
ACCU-CHEK COMPACT |
50924-0988-50 |
$81.67/51 strips |
204/month |
|
ACCU-CHEK GUIDE 50 ct Test Strips |
65702-0711-10 |
$21.56/50 strips |
200/month |
|
ACCU-CHEK SOFTCLIX Lancing Device Kit (Black) |
65702-0400-10 |
$22.63/each |
2/year |
|
ACCU-CHEK FASTCLIX Lancing Device Kit |
65702-0481-10 |
$17.55/each |
2/year |
|
ACCU-CHEK MULTICLIX 102 ct Lancets |
50924-0450-01 |
$15.68/102 lancets |
204/month |
|
ACCU-CHEK SOFTCLIX |
50924-0971-10 |
$13.93/100 lancets |
200/month |
|
ACCU-CHEK FASTCLIX |
65702-0288-10 |
$13.68/102 lancets |
204/month |
|
ACCU-CHEK AVIVA Glucose Control Solution (2 levels) |
65702-0107-10 |
$11.13/bottle |
4/year |
|
ACCU-CHEK COMPACT PLUS CLEAR Glucose Control Solution (2 levels) |
65702-0468-10 |
$11.13/bottle |
4/year |
|
ACCU-CHEK GUIDE Glucose Control Solution (2 levels) |
65702-0713-10 |
$11.13/bottle |
4/year |
|
ACCU-CHEK SMARTVIEW Glucose Control Solution |
65702-0488-10 |
$11.13/bottle |
4/year |
CSRA, 1-800-688-6696