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Frequently Asked Questions North Carolina Medicaid – Designated Preferred Manufacturer Diabetes Testing Supplies Effective 11/15/2009 Prodigy® Produc...

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Frequently Asked Questions North Carolina Medicaid – Designated Preferred Manufacturer Diabetes Testing Supplies Effective 11/15/2009

Prodigy® Products 1. Who will be the designated preferred Medicaid manufacturer for diabetes testing supplies? ¾ The Prodigy® Diabetes Care, LLC (PDC) 2.

Which Prodigy® meters will NC Medicaid cover? ¾ All meters: • Prodigy AutoCode® Blood Glucose Meter Kit – 08484-0701-20. This meter will be the primary meter used by NC Medicaid participants. • Prodigy Pocket™ Blood Glucose Meter Kit (Blue) – 08484-0708-02. All colors of the Prodigy Pocket™ meter are covered under the NC Medicaid Contract. Please stock the Blue Prodigy Pocket™ Meter Kit (70802-B) as this color is the state standard. The following additional colors can be ordered, as needed: o Prodigy Pocket™ Blood Glucose Meter Kit (Black) – 08484-0708-00 o Prodigy Pocket™ Blood Glucose Meter Kit (Pink) – 08484-0708-01 o Prodigy Pocket™ Blood Glucose Meter Kit (Green) – 08484-0708-03 o Prodigy Pocket™ Blood Glucose Meter Kit (Camouflage) – 08484-0708-04 o Prodigy Pocket™ Blood Glucose Meter Kit (Pink Camouflage) – 08484-0708-05 • Prodigy Voice™ Blood Glucose Meter Kit – 08484-0719-50

3. Are Prodigy® meters approved for Alternate Site Testing (AST)? ¾ Yes - palm, forearm, upper arm, thigh and calf. 4. What other non-meter testing supplies are covered by NC Medicaid? • Prodigy® No Coding Test strips (50 ct) – 08484-9902-50 • Prodigy® Control Solution (low) – 08484-9903-10 • Prodigy® Twist Top Lancets 28G (100 ct) – 08484-9903-28 • Lancing Devices, Adj. Depth with Clear Cap – 08484-9903-55 • Prodigy® Syringe 28G, 12.7 mm – 1 cc (100 ct) – 08484-9904-30 • Prodigy® Syringe 31G, 8 mm – ½ cc (100 ct) – 08484-9904-35 • Prodigy® Syringe 31G, 8 mm – 1/3 cc (100 ct) – 08484-9904-38 ** Note that needles and pen tips for administration of insulin remain classified as DME supplies even under this new policy. Those items must continue to be obtained from a DME provider. ** 5. How will patients get the new Prodigy® meters? ¾ Patients can obtain the Prodigy® meters either from their pharmacy or a local DME provider. Since blood glucose meters are non-prescription items, meters may be issued to patients without a prescription. Page 1 of 5

Frequently Asked Questions North Carolina Medicaid – Designated Preferred Manufacturer Diabetes Testing Supplies Effective 11/15/2009

6. Where can pharmacies obtain the new Prodigy® meters? ¾ Pharmacies have the option of obtaining from their wholesalers or ordering from Prodigy® directly. In order to directly purchase from Prodigy®, a pharmacy must order a case quantity minimum (10 meters per case; or 200 bottles of test strips). 7. What about patients on insulin pumps incompatible with Prodigy® products? ¾ There will be an override process available for patients who cannot use Prodigy products for clinical reasons. In this instance the providing pharmacy must be a DME provider ¾ For overrides the following protocol per clinical Policy 5A section 5.5 needs to be adhered to; submit the denial to DMA at the designated Diabetic supply override fax line @ 919-715-3166, along with the required medical necessity forms. Consideration will be given to the request and a written decision will be returned to the provider. 8. What is the contact information for Prodigy®? ¾ 866.540.4816 (For Providers only) ¾ [email protected] ¾ If a patient urgently needs a meter and the pharmacy or local DME provider does not have any Prodigy® meters in stock, the Prodigy® Help Desk should be called (800.243.2636). 9. What are the contents of the original Prodigy® meter kit? ¾ Meter ¾ Battery ¾ Carrying case ¾ Control solution ¾ 10 test strips ¾ 10 lancets ¾ Lancet device ¾ Complete instructions: ¾ Log book ¾ Manual ƒ The Prodigy Voice™ Meter kit also includes an audio CD Manual ¾ Quick reference ¾ Warranty card 10. What if the patient is locked into a pharmacy that chooses not to carry Prodigy products? ¾ The patient should be locked into a secondary pharmacy that does carry Prodigy products. The process of locking a patient into a secondary pharmacy is a manual process that must be done through EDS.

Effective Policy Date Page 2 of 5

Frequently Asked Questions North Carolina Medicaid – Designated Preferred Manufacturer Diabetes Testing Supplies Effective 11/15/2009 11. When will NC Medicaid recognize Point of Sale (POS) transactions? ¾ Effective November 15, 2009 pharmacies will have the option to bill diabetic testing supplies under POS. 12. When will only Single Source Brand “Prodigy®” products be covered? ¾ A transition period will be in place from November 15, 2009, through February 15, 2010 (this transition period is not a postponement), in which a one-time, per-recipient, per-product override will be allowed.

Quantity Limits of Supplies 13. How often will a patient be eligible for a new meter? ¾ Medicaid recipients will be eligible for one (1) meter every two (2) years. 14. What are the quantity limits for diabetes testing supplies paid for by Medicaid? ¾ Quantity limits have not changed with the new policy. • S8490 Insulin syringes (100 syringes per box, any size=1 unit) 200 syringes/month • A4253 Blood glucose test or reagent strips (50 strips=1 unit) 200 strips/month • A4259 Lancets (100 lancets =1 unit ) 200 lancets/month • A4258 Lancing device, each = 2/year • A4256 Normal, high, low calibrator solution = 4/year • E0607 Home blood glucose monitor 1 every 2 years • E2100 Blood glucose monitor with voice synthesizer 1every 3 years

Billing & Reimbursement 15. Will pharmacies have to bill all diabetic supplies for Medicaid recipients under the POS? ¾ No, pharmacies will have the option to bill diabetic testing supplies under DME or POS. NOTE: billing supplies under DME will still require CMN documentation. 16. Will there be an override code for pharmacist to use if Prodigy® products are not available? ¾ A transition period will be in place from November 15, 2009, through February 15, 2010 (this transition period is not a postponement), in which a one-time, per-recipient, per-product override will be allowed. 17. What is the one time Override Code? ¾ DME providers (paper claims, electronic) code: SC modifier 24D on HICFA 1500 and 837P ¾ POS claims code: (two options; may use either) ƒ 461-EU / PA type code field = 1 ƒ 420-DK / Submission Clarification code = 2 Page 3 of 5

Frequently Asked Questions North Carolina Medicaid – Designated Preferred Manufacturer Diabetes Testing Supplies Effective 11/15/2009 18. How often can an override code be used for non-Prodigy® products? ¾ Only one (1) time per product, per recipient during the three (3) month grace period from 11/15/2009 – 2/15/2010. ¾ The transition period is not a postponement. 19. Does a NC DME Certificate of Medical Necessity (CMN) form need to be completed if the pharmacy bills under Point of Sale (POS)? ¾ No, if the dispensing pharmacy bills the testing supplies under POS a CMN will not be required. NOTE: If the pharmacy elects to bill supplies under DME all CMN rules apply. 20. Will batteries be covered? ¾ No, NC Medicaid does not cover batteries. 21. Will reimbursement rates change? ¾ No, current reimbursement for Diabetic supplies billed to DME will remain the same under the Point of Sale. Further reimbursement info can be found at the following link: http:/www.ncdhhs.gov/dma/fee/index.htm 22. Do pharmacies have to be a registered DME provider with the BOP to dispense testing supplies? ¾ No, if the pharmacy is billing under POS, they do not have to be registered with the NC BOP as a DME provider. ¾ The pharmacy will need to be a DME provider if there is a need for quantity or time limit overrides. 23. How will Pharmacies bill for meters? ¾ At the end of each calendar month, you may send to PDC a rebate invoice in a form satisfactory to PDC that lists (a) the amount due, (b) all Prodigy® meter kits that became Eligible Products during that previous month, including, for each Eligible Product, the UPC and NDC number, and (c) the North Carolina Medicaid recipient number of the individual who received the Eligible Product. A duly authorized officer of your company must sign each invoice and must certify it to be completed and accurate. ¾ Within 30 days after PDC receives your correct invoice, PDC will pay you the rebates due for all Eligible Products for that previous quarter. ¾

You must submit all rebate invoices to: Prodigy Diabetes Care, LLC Attn: Order Processing 9300 Harris Corners Parkway - Suite 450 Charlotte, NC 28269-3814 Fax: 704.285.6475

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Frequently Asked Questions North Carolina Medicaid – Designated Preferred Manufacturer Diabetes Testing Supplies Effective 11/15/2009 23. If meters are purchased through wholesalers, how will the pharmacies be reimbursed for the free meters? ¾ At the end of each calendar quarter, you may send to PDC a rebate invoice in a form satisfactory to PDC that lists (a) the amount due, (b) all Prodigy® meter kits that became Eligible Products during that previous quarter, including, for each Eligible Product, the UPC and NDC number, and (c) the North Carolina Medicaid recipient number of the individual who purchased the Eligible Product. A duly authorized officer of your company must sign each invoice and must certify it to be completed and accurate. ¾ ¾

Within 30 days after PDC receives your correct invoice, PDC will pay you the rebates due for all Eligible Products for that previous quarter. You must submit all rebate invoices to:

Prodigy Diabetes Care, LLC Attn: Order Processing 9300 Harris Corners Parkway - Suite 450 Charlotte, NC 28269-3814 Fax: 704.285.6475

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