28 Tex. Admin. Code § 21.2605 - Diabetes Equipment and Supplies

(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;

(7) insulin syringes;

(8) biohazard disposal containers;

(9) insulin pumps, both external and implantable, and associated appurtenances, which include:

(A) insulin infusion devices;

(B) batteries;

(C) skin preparation items;

(D) adhesive supplies;

(E) infusion sets;

(F) insulin cartridges;

(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.

Notes

28 Tex. Admin. Code § 21.2605

The provisions of this §21.2605 adopted to be effective April 13, 1999, 24 TexReg 2939