![]() ![]() SCAN Prime (HMO): Los Angeles, Orange, Riverside, San Bernardino Counties.Scripps Signature offered by SCAN Health Plan (HMO): San Diego County.Scripps Classic offered by SCAN Health Plan (HMO): San Diego County.SCAN Classic (HMO): Los Angeles, Orange, Riverside, San Bernardino, Ventura, Alameda, San Mateo, Fresno, Madera, Clark, Nye, Maricopa, Pima, Pinal, Bexar, Harris, Bernalillo, Sandoval Counties.SCAN Plans with Enhanced Drug Coverage (the coverage of these drugs is not available in other SCAN plans): In addition, if you are receiving extra help to pay for your prescriptions, you will not get any extra help to pay for these drugs. The amount you pay when you fill a prescription for these drugs does not count towards your out-of-pocket costs. These prescription drugs are not normally covered in a Medicare Prescription Drug Plan. Ergocalciferol (Vitamin D2) caps 1.25mg/50,000 units.Cyanocobalamin (Vitamin B12) inj 1000mcg/ml.Generic Viagra (sildenafil 25mg, 50mg, 100mg tab with a maximum 4 tabs/month or 49 tablets/year).Submit an authorization to your patient’s medical group with the appropriate CGM DME supply codes to ensure the CGM gets covered.If you are enrolled in a SCAN plan listed below, these drugs are covered for you on tier 1: What are the next steps to ensure my patient receives their CGMs in a timely manner? They only manage pharmacy authorizations and will not process your request. Please make sure you DO NOT send an authorization request to Express Scripts. For SCAN members, this benefit is managed by the medical group and will not be covered at the pharmacy. Medicare covers CGMs under the DME benefit. Why are CGMs covered under the DME benefit and not the pharmacy benefit (Part D)? This transition fill also allows you time to request authorization (referral) from the medical group to cover and supply CGMs under the DME benefit. Known as a transition fill, this allows patients to have access to these CGM supplies while they are new to the plan. Your patient may have received a temporary fill during their first 90 days of enrollment with SCAN at the pharmacy. My patient previously received a fill at the pharmacy, why is their CGM refill now rejecting? For SCAN members, DME supplies are provided by the medical group’s contracted DME supplier and are not coverable under the pharmacy benefit. Why is my patient’s CGM rejecting/not covered at the pharmacy?ĬGM supplies are covered under the durable medical equipment (DME) benefit under Medicare. Non-adjunctive CGMs can be used as a complete replacement for traditional fingerstick blood glucose testing supplies and do not require a separate blood glucose monitor (BGM) to confirm testing results.Īdjunctive CGMs must be used in conjunction with standard finger stick tests using a home BGM to confirm testing results.īoth non-adjunctive and adjunctive CGMs are considered DME. ![]() What are the differences between non-adjunctive vs. For Medicare coverage policies, please see Local Coverage Determination (LCD): Glucose Monitors (元3822) and Local Coverage Article: Glucose Monitor - Policy Article (A52464). ![]() ▪ History of one level 3 hypoglycemic event (glucose < 54 mg/dL) characterized by altered mental and/or physical state requiring third-party assistance.Īll coverage requests should be submitted through the member’s medical group. ▪ Recurrent (more than one) level 2 hypoglycemic events (glucose < 54mg/dL) that persists despite multiple (more than 1) attempts to adjust medications and/or the diabetes treatment plan OR ![]() ◦ Member has a history of problematic hypoglycemia with documentation of at least one of the following: ◦ Member is being treated with insulin OR
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