Upcoming DME Changes to the Roche Rebate Program for Preferred Roche Diabetic Supplies

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.

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. DME 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 DME fee schedule will be updated to reflect the NDC-associated rates shown in the table below. Non-preferred brand diabetic testing supplies will continue to require prior authorization (PA) and will be reimbursed at the current SMAC rates.

The following chart outlines the Roche diabetic testing supplies with their corresponding preferred NDC number and CPT code, specific reimbursement amounts and current rates for non-preferred brand diabetic testing supplies.

Product

NDC Number

CPT Code

NC Medicaid SMAC Rate

ACCU-CHEK AVIVA PLUS 50 ct Test Strips

65702-0407-10

A4253

$79.63/box of 50

ACCU-CHEK SMARTVIEW 50 ct Test Strips

65702-0492-10

A4253

$79.63/box of 50

ACCU-CHEK COMPACT
51 ct Test Strips

50924-0988-50

A4253

$81.67/box of 51

ACCU-CHEK GUIDE 50 ct Test Strips

65702-0711-10

A4253

$21.56/box of 50

Non-preferred Brand 50 ct Test Strips

N/A

A4253

$29.46/box of 50

ACCU-CHEK SOFTCLIX Lancing Device Kit (Black)

65702-0400-10

A4258

$22.63 each

ACCU-CHEK FASTCLIX Lancing Device Kit

65702-0481-10

A4258

$17.55 each

Non-preferred Brand Spring-powered Device for Lancet, Each

N/A

A4258

$17.55 each

ACCU-CHEK MULTICLIX 102 ct Lancets

50924-0450-01

A4259

$15.68/box of 102

ACCU-CHEK SOFTCLIX
100 ct Lancets

50924-0971-10

A4259

$13.93/box of 100

ACCU-CHEK FASTCLIX
102 ct Lancets

65702-0288-10

A4259

$13.68/box of 102

Non-preferred Brand Lancets, 100 per Box

N/A

A4259

$10.69/box of 100

ACCU-CHEK AVIVA Glucose Control Solution (2 levels)

65702-0107-10

A4256

$11.13/bottle

ACCU-CHEK COMPACT PLUS CLEAR Glucose Control Solution (2 levels)

65702-0468-10

A4256

$11.13/bottle

ACCU-CHEK GUIDE Glucose Control Solution (2 levels)

65702-0713-10

A4256

$11.13/bottle

ACCU-CHEK SMARTVIEW Glucose Control Solution
(2 levels)

65702-0488-10

A4256

$11.13/bottle

Non-preferred Brand Calibrator Solution/Chips, Each

N/A

A4256

$11.13/bottle

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