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Panel debates Medicaid move to pharmacy billing for continuous glucose monitors; committee sends rule to rules committee with no recommendation
Summary
DHS told the committee a rule implementing Act 393 would shift continuous glucose monitor billing to the pharmacy point-of-sale system (making claims eligible for manufacturer rebates). Providers and DMEs debated access, unit prices, and whether rebates benefit beneficiaries or the Medicaid program; the committee voted to send the rule to the rules committee with no recommendation.
The Senate Public Health, Welfare and Labor Committee reviewed a Department of Human Services rule to change how continuous glucose monitors (CGMs) are billed under Medicaid so that pharmacies can adjudicate and be eligible for manufacturer rebates.
Janet Mann, Medicaid director, and Elizabeth Pittman, medical services, explained DHS's reading of Act 393 and said the rule would allow pharmacists and DME vendors to provide CGM benefits while enabling the state to collect pharmacy rebates through the pharmacy point-of-sale system. Mann told the committee that pharmacy adjudication is necessary to secure manufacturer rebates and that those…
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