![]() Windsor Health Plan Windsor Rx Medicare Prescription Drug Plan APPLICATION STATEMENT The application of the Clinical Coverage Guideline is subject to the benefit determinations set forth by the Centers for Medicare and Medicaid Services (CMS) National and Local Coverage Determinations and state-specific Medicaid mandates, if any. WellCare Health Insurance of Arizona, Inc. WellCare Health Plans of New Jersey, Inc. WellCare Health Insurance of Illinois, Inc. ‘Ohana Health Plan, a plan offered by WellCare Health Insurance of Arizona, Inc. HS-138 Continuous Glucose Monitoring Policy Number: HS-138 Revised Date(s): Easy Choice Health Plan, Inc. Some documents are presented in Portable Document Format (PDF). Such links are provided consistent with the stated purpose of this DoD website. For other than authorized government activities,the DHAdoes not exercise any editorial control over the information you may find at other locations. The appearance of hyperlinks to external websites does not constitute endorsement by theDHA of these websites or the information, products or services contained therein. The following diabetic supplies are covered as durable medical equipment : Continuous glucose monitors are a limited benefit Insulin infusion pumps are a covered benefit for beneficiaries with: Insulin-dependent type 1 diabetes mellitus when there is documentation by the physician of poor diabetic control Type 2 diabetes when there is documentation by the physician of poor diabetic control and the patient has failed to achieve glycemic control after six months of multiple daily injection therapy is an official website of theDefense Health Agency (DHA), a component of the Military Health System TRICARE is a registered trademark of the Department of Defense (DoD),DHA. TRICARE is the primary payer for these diabetic supplies. FreeStyle Lite and Precision Xtra blood glucose strips Visit to learn about blood meters, available at no cost to you Bloodand Urine Ketone/Acetone Test Strips Medicare doesn't cover syringes. TRICARE is the primary payer for insulin products. You can get the following diabetic supplies from a military pharmacy, throughhome deliveryor at any TRICARE network pharmacy. ![]() ![]() TRICARE covers diabetic supplies through the pharmacy and medical benefits.
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