Test Strips for Medicare and/or Medicaid Use Only

[farmadiazepine]

Hey,

I need some help here. So, we can order cheaper test strips for every brand of test strips. Every single box of test strips, whether it is Contour, One-Touch, Accu-Chek, etc, says on it "FOR MEDICARE AND/OR MEDICAID USE ONLY" and "NOT FOR RETAIL SALE".

I don't sell them without a prescription.

What I want to know is, can I bill these test strips for Medicare Part D? Also, can I bill these test strips for Medicaid patients who have an HMO? For example, Amerigroup is Medicaid, but its an HMO, and it's provided by Express Scripts.

I just want to know if these strips are STRICTLY for Medicare B claims only, or if they can also be used for Medicare Part D claims and Medicaid HMO claims. I can't find a correct answer anywhere, and recently Bayer sent us a letter telling us we were submitting these claims incorrectly, but when we looked at the list, they were all Medicare Part D claims.

Thanks for the help!

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[Old Timer]

Do they have a different NDC? How does Bayer know what you are billing for?

 

[Ackj]

I was under the impression that they were for Medicare B only, although I agree with you that I haven't found any really solid information about them. I can't be sure at the moment, but I believe the NDC is different, because I know they have different Cardinal reorder numbers. I imagine the 3rd party contacts Bayer about a rebate for dispensing that NDC, which is how they make the whole thing work with the low acquisition cost.


While on the topic of test strips (not just these specific ones), why will Medicare D sometimes pay for them, but sometimes you need to go through Part B? I can't figure out any kind of rhyme or reason. It's just kind of submit to the usual Part D insurance and see if they will deny it. I'd much rather they all go through D since B requires all the extra stuff like diagnosis code.

 

[zelman]

While on the topic of test strips (not just these specific ones), why will Medicare D sometimes pay for them, but sometimes you need to go through Part B? I can't figure out any kind of rhyme or reason. It's just kind of submit to the usual Part D insurance and see if they will deny it. I'd much rather they all go through D since B requires all the extra stuff like diagnosis code.

Usually, it's a Part C HMO plan, not a Part D plan when that happens. In my computer system, they look the same so I don't know until Part B rejects.

 

[farmadiazepine]

They have different NDCs. For example, the regular OneTouch Ultra Blue have their own NDC, and the very cheap that say "Not for Retail Sale. Only for Medicare and Medicaid." have their own separate NDC.

How does Bayer know which ones we are billing for? Because we are allowed to buy them, they are allowed to check with our wholesalers which ones we are buying, whether it's the regular ones or the Medicare ones. In addition, the PBM actually reports to the manufacturer which NDC gets billed. The PBM allowed for the claims to be billed and paid for it. It was Bayer who sent us the letter saying they were immediately ending th contract because we weren't following their agreement.

I am just confused because the box says Medicare and Medicaid. I assumed Part D was okay and any HMO Medicaid plan was okay.

 

[Old Timer]

They have different NDCs. For example, the regular OneTouch Ultra Blue have their own NDC, and the very cheap that say "Not for Retail Sale. Only for Medicare and Medicaid." have their own separate NDC.

How does Bayer know which ones we are billing for? Because we are allowed to buy them, they are allowed to check with our wholesalers which ones we are buying, whether it's the regular ones or the Medicare ones. In addition, the PBM actually reports to the manufacturer which NDC gets billed. The PBM allowed for the claims to be billed and paid for it. It was Bayer who sent us the letter saying they were immediately ending th contract because we weren't following their agreement.

I am just confused because the box says Medicare and Medicaid. I assumed Part D was okay and any HMO Medicaid plan was okay.

You have a contract. You have to read the contract or have your attorney read the contract. Technically if the part D pays it's because they are a Medicare Advantage Plan. Those patient's have opted out of Medicare, so they are probably not eligible for these strips. I don't know about Medicaid HMO's as the states place the people in them.

 

[MountainPharmD]

I thought these strips were for Medicaid or Medicare mail order billing only. Hence the reason they say not for retail sale on them.

 

[farmadiazepine]

I don't know and I can't get a clear answer. Thanks for the help everyone.

 

[Sparda29]

Speaking of Medicare and Medicaid, when patients who are on Medicare and Medicaid bring in coupons from their doctor for scripts for Xigduo and Farxiga, but it's nonformulary what to do? Does the no Medicare/Medicaid patients still apply since it's nonformulary?

 

[txpharmguy]

Speaking of Medicare and Medicaid, when patients who are on Medicare and Medicaid bring in coupons from their doctor for scripts for Xigduo and Farxiga, but it's nonformulary what to do? Does the no Medicare/Medicaid patients still apply since it's nonformulary?

As long as you're billing directly to the manufacturer coupon and not to any federally funded plan, then that's ok

 

[farmadiazepine]

As long as you do not receive any reimbursement from any federally funded plan you are good to go. That's my general understanding, however, there are some coupons that explicitly state that the coupon cannot be used for any patient who is ELIGIBLE for Medicare. That means even if they have a private plan and are eligible for Medicare Part D, they still can't use a copay card? Like WTF!?

I have come to realize all these coupons are not the same. You have to read eligibility requirements for each one, and figure it out. I use coupons for ADAP patients who have private insurance and am able to collect entire copays from a coupon, as opposed to ADAP simply reducing the entire reimbursement, and in the eligibility section, its allowed. I'm talking about Triumeq copay assistance.

So it depends on the drug and the coupon.

There are coupons specifically made for Medicare Part D patients apparently. I think Brilinta offers them.

 

[zelman]

As long as you're billing directly to the manufacturer coupon and not to any federally funded plan, then that's ok

Are federal employees' insurance considered to be "federally funded"?

 

[txpharmguy]

Are federal employees' insurance considered to be "federally funded"?

I would say yes because most of the coupons say ineligible if insurance is funded in part or in whole by the federal government.

 

[BidingMyTime]

Are federal employees' insurance considered to be "federally funded"?

Yes, legally they are considered federally funded. This issue came up with a small employer group in my area, that I would never have considered federally funded, but apparently they legally were because of the percentage of grants that they received from the federal government. We were told all federal employees are considered as federally funded, and some private employees are also considered federally funded if they are getting a significant amt of federal grants.

 

[BidingMyTime]

To the OP, I really don't know, but I think those special test strips you are talking about, are actually only for mail-order Medicare/Medicaid patients. I have never seen them at a retail store, the only time I've seen them is a couple of times when people bring them in from a mail-order pharmacy & want us to transfer them (we do & fill with the regular NDC that we carry.)