20-662 Expanded Access to Diabetic Test Strips and Supplies
Date: 09/01/20
This information applies to Participating Physician Groups (PPGs) and Hospitals.
Cal MediConnect Plan (Medicare-Medicaid Plan) members can access supplies through a network pharmacy at no cost
Effective January 1, 2021, Health Net Cal MediConnect members can get their diabetic supplies through a Health Net network pharmacy. This change helps increase access to diabetic supplies that may otherwise be required through mail order.
Network pharmacies have the following preferred brands available for diabetic supplies at no cost:
- One Touch® by Lifescan
- Accu-Check® by Roche
Non-preferred brands require prior authorization before the member can obtain diabetic supplies at a Health Net network pharmacy.
Medical necessity continues to be managed according to physicians’ instructions to patients.
Urgent access
If a member has an urgent need for diabetic supplies and their physician gives them a prescription to pick up supplies at a network pharmacy, the member can go to any Health Net network pharmacy to obtain preferred diabetic supplies. Non-preferred brands require prior authorization.
Global and dual-risk entities
Diabetic supplies remain under capitation, but effective January 1, 2021, physicians have options on where to direct their patients for their blood glucose monitor (BGM) and diabetic supplies. Physicians can continue to direct patients to the contracted vendor affiliated with the participating physician group (PPG) or hospital, or patients can be referred directly to any Health Net network pharmacy.
The financial responsibility for diabetic supplies will follow the terms of your Provider Participation Agreement (PPA), as specified on the division of financial responsibility (DOFR), with diabetic supplies filled through network pharmacies deducted from capitation.
This allows members to receive necessary supplies as directed by their physician, with enhanced access if they need supplies more quickly.
There may be differences in the BGM and test strips used by the PPG or hospital, so if a member is referred to a network pharmacy, they will receive a new BGM if they are required to change the brand of test strips. If a non-preferred brand is recommended, the physician must submit an exception request to document why the member is not able to use a preferred brand.
Shared-risk PPGs
Diabetic supplies will no longer be available through E-Medical, Inc.
Effective January 1, 2021, we will be working with the prescribing physicians to get new prescriptions for diabetic supplies which can be filled through any Health Net network pharmacy.
Either One Touch® by Lifescan or Accu-Check® by Roche are the preferred brands.
Additional information
Providers are encouraged to access Health Net’s provider portal online at provider.healthnet.com for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.
To locate the Health Net Formulary or a listing of Health Net contracted pharmacies visit https://ca.healthnetadvantage.com/prescription-drugs-formulary/find-a-pharmacy.html.
For all other questions, contact the Health Net Provider Services Center by county within 60 days at:
Line of Business | Telephone Number | Email Address |
Cal MediConnect – Los Angeles County | 1-855-464-3571 | |
Cal MediConnect – San Diego County | 1-855-464-3572 |