Blood Glucose Test Strips

SELF ADMINISTRATION

The following are the preferred Blood Glucose Test Strips:

  • Freestyle Insulinx
  • Freestyle Lite
  • Freestyle
  • Precision Xtra
  • Onetouch Ultra
  • Onetouch Verio

 

All other Blood Glucose Test Strips are non-preferred and require prior authorization

Patients must meet the following criteria for all non-preferred Blood Glucose Test Strips:

  • Medical record documentation is provided and supports a medically appropriate reason why the preferred Brand Test Strips (i.e., Freestyle Insulinx, Freestyle Lite, Freestyle, Precision Xtra, Onetouch Ultra, Onetouch Verio) cannot be considered

Approval:

  • 1 year