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Provider Type(s): ALL
Florida Medicaid Transfer of Diabetic Supply Coverage from the Durable Medical Equipment Benefit to the Pharmacy Benefit
The Agency for Health Care Administration (Agency) is modifying the way diabetic supplies are provided to Floridians served through the State’s Medicaid program. The Agency remains committed to bettering care by ensuring Medicaid beneficiaries receive medically necessary services to prevent and treat diabetes.
The Agency will be able to reimburse continuous glucose monitors (including their transmitters and sensors), insulin pumps, blood glucose monitors, blood glucose test strips, syringes, pen needles, lancets, sharps containers, control solutions and alcohol swabs through the Medicaid Pharmacy Services benefit. This initiative broadens access to care while enhancing fiscal predictability and financial management. Details on the transition of diabetic supplies from the durable medical equipment (DME) benefit to the pharmacy benefit are included below.
Increasing Access
To increase access to medically necessary care to prevent and treat diabetes, patients will be able to obtain diabetic supplies at pharmacy locations they currently use for their prescribed drugs and other essentials. Diabetic supplies, such as Continuous Glucose Monitors, will now be available at most Medicaid participating pharmacies, making these products more accessible to the children who need them.
Lowering Cost
By offering this benefit through the pharmacy, Florida Medicaid can take advantage of rebates from the manufacturers of diabetic supplies, which will lower the cost of diabetic supplies for the State. The Agency will also develop a preferred product list for patients to have quality products available without prior authorization. This is another effort to better serve Medicaid beneficiaries.
The Plan
In the coming months, the Agency will begin rulemaking to update the necessary coverage policies, incorporated by reference in Florida Administrative Code. The Agency will also amend the Florida Medicaid State Plan and Statewide Medicaid Managed Care plan contracts to reflect this change. Public participation is encouraged as the Agency moves forward in implementing these changes. All interested parties should visit the Agency’s website and sign up to receive Agency alerts that will be made available to the public throughout the implementation process.
The Agency is excited to announce this initiative to continue to champion our mission: to provide better health care for all Floridians.
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