Do the PDSL and the new billing requirements apply to third-party liability (TPL) claims?
If a member has TPL, and the blood glucose monitor and/or diabetic test strips is/are covered by the other payer, members do not have to use a product on the PDSL, but the provider is required to submit the appropriate National Drug Code (NDC) and procedure code combination. If the other payer does not cover blood glucose monitors and/or diabetic test strips, the member must use a product on the PDSL, and the provider is required to submit the appropriate NDC and procedure code combination. If the member is unable to use the products on the PDSL due to a medical reason, a prior authorization (PA) must be requested for the products not listed on the PDSL.
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