Continuous Glucose Monitoring Systems Coverage Transition

Friday, May 29, 2020

Effective July 1, 2020, coverage of therapeutic Continuous Glucose Monitoring (CGM) products will transition from the Durable Medical Equipment (DME) Program to the Outpatient Pharmacy Point of Sale Program. The products will be included on the NC Medicaid and Health Choice Preferred Drug List (PDL).

To help ensure a smooth transition, prior authorizations (PAs) obtained through the DME program for therapeutic CGM products that are active at the time of transition will be converted to pharmacy PAs in NCTracks. Coverage of non-therapeutic CGM products will not transition and will remain under the DME program and billing for these supplies should continue through the DME program. 

Beginning July 1, 2020, new and existing therapeutic CGM users must obtain their CGM supplies from an enrolled NC Medicaid pharmacy provider of their choice. All claims for therapeutic CGM products will be processed through pharmacy Point of Sale (POS) billing.

  • Therefore, all CGM products will require an active and valid prescription at the filling pharmacy on file.
  • The PDL Preferred therapeutic CGM products will be the Dexcom G5 and G6.
  • The Freestyle Libre will be Non-Preferred.

Pharmacies are encouraged to order sufficient inventory of the CGM products to satisfy beneficiary demand during this transition.

Contact

NCTracks Contact Center: 800-688-6696