Current through Reg. 50, No. 13; March 28, 2025
(a) A
health benefit plan shall provide coverage for equipment and supplies for the
treatment of diabetes for which a physician or practitioner has written an
order, including:
(1) blood glucose monitors,
including those designed to be used by or adapted for the legally
blind;
(2) test strips specified
for use with a corresponding glucose monitor;
(3) lancets and lancet devices;
(4) visual reading strips and urine testing
strips and tablets which test for glucose, ketones and protein;
(5) insulin and insulin analog
preparations;
(6) injection aids,
including devices used to assist with insulin injection and needleless
systems;
(8) biohazard disposal
containers;
(9) insulin pumps, both
external and implantable, and associated appurtenances, which include:
(A) insulin infusion devices;
(C) skin preparation items;
(G) durable and disposable devices to assist
in the injection of insulin; and
(H) other required disposable
supplies;
(10) repairs
and necessary maintenance of insulin pumps not otherwise provided for under a
manufacturer's warranty or purchase agreement, and rental fees for pumps during
the repair and necessary maintenance of insulin pumps, neither of which shall
exceed the purchase price of a similar replacement pump;
(11) prescription medications which bear the
legend "Caution: Federal Law prohibits dispensing without a prescription" and
medications available without a prescription for controlling the blood sugar
level;
(12) podiatric appliances,
including up to two pairs of therapeutic footwear per year, for the prevention
of complications associated with diabetes; and
(13) glucagon emergency kits.
(b) As new or improved treatment
and monitoring equipment or supplies become available and are approved by the
United States Food and Drug Administration, such equipment or supplies shall be
covered if determined to be medically necessary and appropriate by a treating
physician or other practitioner through a written order.
(c) All supplies, including medications, and
equipment for the control of diabetes shall be dispensed as written, including
brand name products, unless substitution is approved by the physician or
practitioner who issues the written order for the supplies or
equipment.
