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December 29, 2021
CareSource Continuous Glucose Monitor Coverage Update

On November 15, 2021, CareSource announced changes to coverage of Continuous Glucose Monitors (CGM). Partners For Kids reiterated these changes in the December 2021 Newsletter update. CareSource has rescinded the related notices, and is not currently implementing any change to CGM coverage. As such, CGMs will continue to be covered through both Pharmacy and Medical benefits. Read below for further details and links to an updated change notice, as well as links to CareSource policies.

Key Points:

  • Continuous Glucose Monitor devices can be acquired through either the medical or pharmacy benefit for patients with CareSource (Ohio Medicaid).
  • Below are links to the current Medical and Pharmacy policies.

Change Notice from CareSource 

CareSource Medical Policy for Continuous Glucose Monitors 

CareSource Pharmacy Policy for Continuous Glucose Monitors

CareSource Pharmacy PA Request Form 

CareSource Provider Services number: 1-800-488-0134 which is active Monday through Friday 8 a.m. to 6 p.m. EST.

CareSource Fax Number for Pharmacy Prior Authorization process: 1-866-930-0019

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