Glucose Test Strips and Meters Step Therapy Program Summary
Policy Number: PH-1042
For Commercial, Blue Partner, GenPlus and Health Insurance Marketplace formularies preferred products are Ascensia products.
INDICATIONS AND DOSAGE1
Glucose Test Strips and appropriate meters are indicated to be used for quantitatively measuring glucose in indicated blood samples. Strips and associated meters are intended for use outside the body by people with diabetes for self-monitoring of blood glucose at home and by healthcare professionals in the clinical setting, as an aid to monitor the effectiveness of diabetes control.
NOTE: This table is not inclusive of all available diabetic test strips.
Available Brand Products
Nova Max® products
One Drop® products
Pogo Automatic® products
True Metrix® products
Blood glucose test strip, Blood glucose test meter
All-In-One Glucose Meter System
There are many choices of meters and test strips to choose from. Individuals should choose the device based on ease of use, cost and insurance coverage, information retrieval, and flexibility.1
The evidence is insufficient regarding when to prescribe blood glucose monitors (BGM) and how often testing is needed for insulin-treated people with diabetes who do not use intensive insulin regimens, such as those with type 2 diabetes using basal insulin with or without oral agents and/or non-insulin injectables. In people with type 2 diabetes not using insulin, routine glucose monitoring may be of limited additional clinical benefit. For some individuals, glucose monitoring can provide insight into the impact of nutrition, physical activity, and medication management on glucose levels. Glucose monitoring may also be useful in assessing hypoglycemia, glucose levels during intercurrent illness, or discrepancies between measured A1C and glucose levels when there is concern an A1C result may not be reliable in specific individuals. For patients using basal insulin, assessing fasting glucose with blood glucose monitoring to inform dose adjustments to achieve blood glucose targets results in lower A1C. For many individuals on intensive insulin regimens using BGM, this requires checking up to 6-10 times daily.2
- Device technology – better blood glucose meters and more. https://www.diabetes.org/diabetes/device-technology.
- Diabetes Technology: Standards of Medical Care in Diabetes—2023. American Diabetes Association. http://diabetesjournals.org/care/issue/46/Supplement_1.
Glucose Test Strips and Meters Step Therapy
Non-preferred Glucose Cartridges, Test Strips, or All-In-One Glucose Meter Systems
PRIOR AUTHORIZATION CRITERIA FOR APPROVAL
A nonpreferred glucose cartridge, test strip, or all-in-one glucose meter system product will be approved when ONE of the following is met:
- The patient’s medication history includes use of any preferred glucose cartridge, test strip, or all-in-one glucose meter system within the past 90 days
- ONE of the following:
- Patient has visual impairment
- Patient uses an insulin pump OR continuous glucose monitor that is not accommodated with a preferred glucose cartridge, test strip, or all-in-one glucose meter system
- Patient has a physical or a mental disability
Length of Approval: 12 months
This pharmacy policy is not an authorization, certification, explanation of benefits or a contract. Eligibility and benefits are determined on a case-by-case basis according to the terms of the member’s plan in effect as of the date services are rendered. All pharmacy policies are based on (i) information in FDA approved package inserts (and black box warning, alerts, or other information disseminated by the FDA as applicable); (ii) research of current medical and pharmacy literature; and/or (iii) review of common medical practices in the treatment and diagnosis of disease as of the date hereof. Physicians and other providers are solely responsible for all aspects of medical care and treatment, including the type, quality, and levels of care and treatment.
The purpose of Blue Cross and Blue Shield of Alabama’s pharmacy policies are to provide a guide to coverage. Pharmacy policies are not intended to dictate to physicians how to practice medicine. Physicians should exercise their medical judgment in providing the care they feel is most appropriate for their patients.
Neither this policy, nor the successful adjudication of a pharmacy claim, is guarantee of payment.