Does Navicare Cover Contour Next Gen Glucose Strips in Mass.

For residents of Massachusetts who rely on NaviCare for their healthcare needs, one of the most critical questions for diabetics is whether Contour Next Gen glucose test strips are covered under their plan. Accurate and affordable glucose monitoring is essential for diabetes management, and understanding your plan’s coverage is key to staying healthy and minimizing out-of-pocket costs.

Understanding NaviCare: A Dual-Eligible Health Plan in Massachusetts

NaviCare is a Medicare Advantage Special Needs Plan (SNP) offered by Fallon Health, specifically tailored for individuals aged 65 or older who are eligible for both Medicare and MassHealth (Medicaid). This dual-eligible plan provides comprehensive medical, prescription drug, and long-term care services.

NaviCare offers two plans:

• NaviCare HMO SNP – for people who have Medicare and MassHealth Standard

• NaviCare SCO (Senior Care Options) – for people who have MassHealth Standard but not Medicare

Both versions offer extra benefits beyond what standard Medicare and Medicaid provide, such as vision, hearing, dental, and over-the-counter (OTC) allowances. This includes specific coverage for diabetes supplies, which often include glucose meters and testing strips.

What Are Contour Next Gen Glucose Strips?

Contour Next Gen glucose test strips are among the most popular and reliable options for blood glucose monitoring. Manufactured by Ascensia Diabetes Care, these strips are designed to be used exclusively with the Contour Next series meters, offering:

• Highly accurate readings

• No coding technology

• Small blood sample requirement

• Fast results within seconds

These strips are FDA-approved and favored by many endocrinologists due to their precision and consistency.

Coverage of Glucose Test Strips Under NaviCare

NaviCare’s Coverage for Diabetic Supplies

NaviCare covers a wide range of diabetic supplies under Medicare Part B and Durable Medical Equipment (DME) benefits, provided the supplies are medically necessary and prescribed by a healthcare provider. This includes:

• Blood glucose monitors

• Blood glucose test strips

• Lancets and lancing devices

• Control solutions for test strips

However, coverage may depend on the specific brand and manufacturer approved under the plan’s preferred vendor list or formulary.

Does NaviCare Specifically Cover Contour Next Gen Strips?

As of the latest information, NaviCare does not universally guarantee coverage for all brands of glucose test strips, including Contour Next Gen. Coverage often hinges on whether:

• The Contour Next Gen strips are on NaviCare’s formulary or DME-approved list

• The strips are obtained from a network-approved provider or pharmacy

• The prescribing physician provides documentation of medical necessity

Fallon Health and NaviCare typically use preferred suppliers for diabetic testing supplies. In many cases, OneTouch and Accu-Chek brands are more commonly listed as preferred brands within Medicare Advantage plans.

Still, exceptions can be made if a physician submits a prior authorization request citing a specific medical need for Contour Next Gen strips.

How to Confirm Coverage for Contour Next Gen Strips with NaviCare

To ensure whether Contour Next Gen glucose test strips are covered, follow these steps:

1. Contact NaviCare Member Services

   • Call the number on the back of your member ID card.

   • Ask specifically whether Contour Next Gen test strips are on the covered DME or pharmacy list.

2. Review the NaviCare Formulary or DME List

   • Visit the Fallon Health NaviCare website and look for the Part B DME Supplies List or formulary search tool.

3. Speak With Your Primary Care Provider or Care Coordinator

   • Your care team may assist in obtaining authorization or switching to a preferred test strip brand if coverage is denied.

4. Check With Network Pharmacies or DME Vendors

   • Only obtain testing supplies from in-network vendors to avoid denied claims.

   • Ask the pharmacy to check whether Contour Next Gen strips are billable under your plan.

Alternative Options If Contour Next Gen Is Not Covered

If Contour Next Gen is not covered under NaviCare, consider the following alternatives:

1. Switching to a Covered Brand

• Ask your physician if switching to a covered test strip brand (like OneTouch Verio or Accu-Chek Guide) is appropriate for your diabetes management.

2. Requesting a Prior Authorization

• If you have a medical necessity or have previously used Contour Next Gen strips with success, your doctor can request an exception or prior authorization.

3. Utilizing Over-the-Counter Benefits

• NaviCare plans often include quarterly OTC allowances. While these funds are usually for non-prescription items, some plans may allow purchase of glucose strips if the strips are available through the approved OTC catalog.

How Much Will Contour Next Gen Strips Cost Out-of-Pocket?

If not covered by NaviCare, Contour Next Gen test strips may still be available out-of-pocket. Costs can vary:

• Retail price for 100 strips: $40–$80

• Online bulk purchases or pharmacy discounts (GoodRx, SingleCare) can reduce costs significantly

• Manufacturer coupons from Ascensia may also help offset pricing

However, paying out-of-pocket should only be a last resort, especially if other medically equivalent and covered brands are available at no cost to you.

Conclusion: Navigating Glucose Test Strip Coverage with NaviCare in MA

Navigating test strip coverage under NaviCare in Massachusetts requires due diligence. While Contour Next Gen strips are highly regarded for their accuracy and ease of use, they may not always be included on NaviCare’s preferred coverage list. It’s critical to:

• Check directly with NaviCare or Fallon Health

• Speak with your primary care provider

• Explore formulary alternatives

• Consider prior authorization if medically necessary

By staying proactive, members can access the supplies they need to manage diabetes effectively while minimizing out-of-pocket costs.