Insurance Updates

If there are any insurance policy changes that could affect our patient population, it will be posted below along with any relevant links for further information. Be sure to sign up for our newsletter to receive any important alerts from our Pediatric Diabetes Team.

Medicaid and CSHCS Continuous Glucose Monitor Coverage

As many of you are aware, long awaited continuous glucose monitor (CGM) coverage changes under Medicaid have recently gone into effect. While we are glad to see Medicaid expanding qualifying coverage for this important device, we are being told by suppliers that there is a mismatch in reimbursement rates and the cost of the devices, causing the durable medical equipment company (DME) to reject applications for devices. If you have concerns about not getting CGM supplies after following the correct application process, you should send an email to start a record for the State to track to msapolicy@michigan.gov.

 

If you have questions or concerns, we encourage you to contact your insurance provider and/or reach out to the following contacts: 
 
Kathy Stiffler
Acting Deputy Director for Medical Services (Medicaid Director)
Michigan Department of Health and Human Services
StifflerK@michigan.gov
 
Meghan Hodge Green
Health Policy Advisor
Office of Governor Gretchen Whitmer
GroenM@michigan.gov
 
Lisa Trumbell
DMEPOS Policy Specialist
TrumbellL@michigan.gov or call 517-284-1226.

Changes to Insulin Coverage

You may have received a letter recently from your insurance company informing you of changes to your insulin coverage. Many insurance plans are requiring patients to switch their rapid-acting insulin to Admelog, which is biosimilar to Humalog. If this is the case for you, please talk to your doctor about filling a new prescription for Admelog. If you use a half-unit pen, please be aware that Admelog does not offer a half-unit pen option. Talk to your diabetes care team about how you can continue using half units if necessary.

Blue Cross Blue Shield

Starting June 1st, 2018, Blue Cross Blue Shield of Michigan will no longer cover the following insulin products:

  • Apidra, Apidra Solostar

  • Humalog, Humalog Mix

  • Humulin (except U-500), Humulin Kwikpen

Patients may continue to fill prescriptions for these insulin products through May 31, 2018. If you continue to place orders for these products after May 31, you will be responsible for the full cost.

Blue Cross Blue Shield will instead cover Novolin (all forms), Novolog, and Novolog Mix. For questions, please contact Blue Cross Blue Shield

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