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    BT 2022119

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    Indiana Family to Family
    The Indiana Health Coverage Programs (IHCP) has revised the Preferred Diabetes Supply List (PDSL) that was previously announced to take effect on January 1, 2023. The revision was necessary due to some product discontinuations that would have impacted the original PDSL. The revised PDSL maintains preferred products from Dexcom, Roche, and Trividia, and allows members additional time to transition to preferred test strips by not requiring prior authorization for some nonpreferred strips through March 31, 2023. Providers should refer to the revised PDSL on the OptumRx Indiana Medicaid website and follow the claims submission guidance in the provider reference modules.

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    BT 2022119

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    Indiana Family to Family
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    The Indiana Health Coverage Programs (IHCP) has revised the Preferred Diabetes Supply List (PDSL) that was previously announced to take effect on January 1, 2023. The revision was necessary due to some product discontinuations that would have impacted the original PDSL. The revised PDSL maintains preferred products from Dexcom, Roche, and Trividia, and allows members additional time to transition to preferred test strips by not requiring prior authorization for some nonpreferred strips through March 31, 2023. Providers should refer to the revised PDSL on the OptumRx Indiana Medicaid website and follow the claims submission guidance in the provider reference modules.

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    IHCP revises recently announced Preferred Diabetes Supply List updates

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    Bt 2022119

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    The Indiana Health Coverage Programs (IHCP) has revised the Preferred Diabetes Supply List (PDSL) that was previously announced to take effect on January 1, 2023. The revision was necessary due to some product discontinuations that would have impacted the original PDSL. The revised PDSL maintains preferred products from Dexcom, Roche, and Trividia, and allows members additional time to transition to preferred test strips by not requiring prior authorization for some nonpreferred strips through March 31, 2023. Providers should refer to the revised PDSL on the OptumRx Indiana Medicaid website and follow the claims submission guidance in the provider reference modules.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    47 views2 pages

    BT 2022119

    Uploaded by

    Indiana Family to Family
    The Indiana Health Coverage Programs (IHCP) has revised the Preferred Diabetes Supply List (PDSL) that was previously announced to take effect on January 1, 2023. The revision was necessary due to some product discontinuations that would have impacted the original PDSL. The revised PDSL maintains preferred products from Dexcom, Roche, and Trividia, and allows members additional time to transition to preferred test strips by not requiring prior authorization for some nonpreferred strips through March 31, 2023. Providers should refer to the revised PDSL on the OptumRx Indiana Medicaid website and follow the claims submission guidance in the provider reference modules.

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    of 2

    IHCP bulletin

    INDIANA HEALTH COVERAGE PROGRAMS BT2022119 DECEMBER 29, 2022

    IHCP revises recently announced Preferred


    Diabetes Supply List updates
    The Indiana Health Coverage Programs (IHCP) recently announced updates to the
    Preferred Diabetes Supply List (PDSL), effective for dates of service (DOS) on or after
    Jan. 1, 2023 (see IHCP Bulletin BT2022113).

    The Indiana Family and Social Services Administration (FSSA) was subsequently notified
    of product discontinuations that would impact the PDSL. As a result, the IHCP has
    revised the PDSL to be implemented on Jan. 1, 2023 (see Table 1).

    Table 1 – Revised Preferred Diabetes Supplies List, effective for claims with DOS on or after Jan. 1, 2023

    Dexcom Products
    Receiver Corresponding Sensor/Transmitter
    Dexcom G6 Sensors
    Dexcom G6 Receiver
    Dexcom G6 Transmitter
    Roche Products
    Meters Corresponding Strips
    Accu-Chek Guide Care Kit
    Accu-Chek Guide Test Strips
    Accu-Chek Guide Me Care Kit
    Trividia Products
    Meters Corresponding Strips
    TRUE METRIX Meter
    TRUE METRIX Test Strips
    TRUE METRIX Air Meter
    ReliOn Rx TMX Blood Glucose System ReliOn/TRUE METRIX Test Strips

    To allow members time to transition to preferred diabetes supplies products, the IHCP will not require prior
    authorization on the following nonpreferred blood glucose test strips until April 1, 2023:

    ◼ FreeStyle strips
    ◼ FreeStyle Insulinx strips
    ◼ FreeStyle Lite strips

    For more information


    The PDSL can be found on the OptumRx Indiana Medicaid website, accessible from the Pharmacy Services page at
    in.gov/medicaid/provider. Pharmacy providers should refer to the Pharmacy Services provider reference module for
    current guidance regarding fee-for-service (FFS) claims for PDSL products. Durable medical equipment (DME)
    providers must continue to use the claim submission processes outlined in the Durable and Home Medical Equipment
    and Supplies provider reference module.

    Page 1 of 2
    IHCP bulletin BT2022119 DECEMBER 29, 2022

    Please direct PDSL-related questions about FFS members to the OptumRx Clinical and
    Technical Help Desk by calling toll-free 855-577-6317. Questions regarding benefits and
    claims for members in Healthy Indiana Plan (HIP), Hoosier Care Connect and Hoosier
    Healthwise should be directed to the managed care entity (MCE) with which the member
    is enrolled.

    COPIES OF THIS PUBLICATION SIGN UP FOR IHCP EMAIL NOTIFICATIONS


    If you need additional copies of this publication, To receive email notices of IHCP publications, subscribe
    please download them from the IHCP Bulletins by clicking the blue subscription envelope
    page of the IHCP provider website at or sign up from the IHCP provider website
    in.gov/medicaid/providers. at in.gov/medicaid/providers.

    Page 2 of 2

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