Beginning July 1, 2013, precertification will be required by Oxford for certain non-preferred diabetic brands of insulin, medications, and supplies, but not all. The precertification process will review the non-preferred medications and supplies for Medical Necessity compared to other clinically equivalent preferred alternatives available within the same therapeutic class.
To initiate the precertification process, your physician must call Oxford and provide all relevant clinical data to support the need to use the non-preferred medication or supply. If your physician prescribes a preferred medication or supply, he or she will not need to obtain precertification. For further details, please refer to the Amendment attached:
This is the list of non-preferred diabetes medications and supplies that will be subject to precertification by Oxford effective July 1, 2013. This list may change over time.
Glucose Test Strips and Meters
Bayer Healthcare
Ascensia Autodisc
Breeze 2
Contour
Contour Next
Abbott Diabetes
Freestyle Insulinx
Freestyle Lite
Freestyle
Precision Xtra
Insulin Vials/Pens/Cartridges
Novolog
Apidra/Apidra Solostar
Novolog Mix 70-30
Novolin 70-30
Novolin N
Novolin R
Oral and Injectible Diabetic Agents for controlling blood sugar (DPP-4 Inhibitors)
Januvia
Janumet/Janumet XR
If you have questions about your coverage or need assistance, please call the Pharmacy Customer Service member telephone number on the back of your ID card, or contact your insurance broker.