HMSA Medicare Advantage® Diabetic Test Strips

Diabetic Test Strip Policy

All HMSA Medicare plans including, Akamai Advantage PPO, DSNP, and EGWP will apply the Local Coverage Determination (LCD) L33822 coverage indications whether the member obtains their diabetic test strips from a pharmacy or through a certified DME supplier.

Background

Medicare Part B covers blood glucose testing supplies. Glucose test strips, glucose monitors, and related supplies are Part B benefits that are covered at no cost to the member under our Medicare Advantage plans. The amount of covered supplies varies on whether the individual uses insulin or not.

This policy is applied when claims are submitted to HMSA from a certified DME supplier, and when claims are submitted to HMSA’s PBM for diabetic test strips at point of sale (pharmacy).

• Additional information on Diabetic test strips and supplies can be found CMS Medicare Coverage Database (MCD) under Local Coverage Determination (LCD) L33822.
• Glucose test strips, glucose monitors, and related supplies are benefits under Part B of Medicare.

Quantity Limit

Usual Utilization

• For patients who are non-insulin dependent: up to 100 test strips for a 90-day supply
• For patients who are insulin dependent: up to 300 test strips for a 90-day supply

High Utilization

• For patients who are non-insulin dependent: more than 100 test strips for a 90-day supply who meet LCD L33822 coverage criteria. *See Prior authorization requirements
• For patients who are insulin dependent: more than 300 test strips for a 90-day supply who meet LCD L33822 coverage criteria. *See Prior authorization requirements

Preferred Brands & Manufacturers

As allowed by CMS, HMSA has designated preferred brands and manufacturers for diabetic test strips and glucose monitors. This list may change, please refer to this page for the current listing.

2025 Products:

• FreeStyle
• FreeStyle InsuLinx
• FreeStyle Lite
• FreeStyle Precision Neo
• OneTouch Ultra 2
• OneTouch Verio
• Precision Xtra

2026 Products:

• Accu-Chek Aviva Plus In Vitro Strip
• Accu-Chek Guide In Vitro Strip
• Accu-Chek SmartView In Vitro Strip
• FreeStyle InsuLinx Test In Vitro Strip
• FreeStyle Lite Test In Vitro Strip
• FreeStyle Precision Neo Test In Vitro Strip
• FreeStyle Test In Vitro Strip
• Precision Xtra Blood Glucose In Vitro Strip

*Note: Any monitor that can be used with the above brands is covered by the plan. Please verify availability of test strip brands and monitors at your local pharmacy.

New Prescription

If the patient needs to change to a preferred brand or requires additional test strips beyond the current quantity limit, they may need a new prescription or a prior authorization.

New Glucose Monitor

If the patient requires a new glucose monitor to use one of the preferred test strips, please direct them to the appropriate manufacturer:

2025 Instructions:

Freestyle/Abbot

Diabetes Care at 1-866-224-8892 with Offer Code 8WXGP8MB

2026 Instructions:

Roche ACCU-CHEK

1. Get 2 prescriptions: one for the meter (Guide or Guide Me) and one for Accu-Chek Guide test strips.

2. Present prescriptions and voucher at a retail pharmacy.

   Voucher Info:

   BIN: 610524

   RxPCN: 1016

   Group: 40026479

   ID: 369168840

   Issuer: (80840)

ABBOTT FreeStyle

Call 1-800-680-6850

CVS Offer Code: 8WXGP8MB

Grace Period for Transition to a Preferred Brand

At any time during the year, members new to HMSA Medicare Advantage who are using a non-preferred brand may receive a one-time fill.

Prior Authorization

If a member requires more test strips than the quantity limits under usual utilization, or the preferred brands are not appropriate for their medical needs, they should contact their prescriber who will be required to submit a pre-authorization to HMSA Medical Management. See Frequently Asked Questions: Precertification for more information on this process.

Revision History