Covered diabetic supplies for Kaiser Permanente Maryland Health Connection Plans

Kaiser Permanente Value Plans offered on Maryland Health Connection cover services to treat and manage diabetes and diabetic supplies at a $0 copay, with no deductible or coinsurance. The items below are covered when medically necessary and you get them from your health plan's pharmacies or locations.

Diabetes supplies and services covered at $0 for patients with a primary diagnosis of diabetes

Covered by outpatient services

Continuous Glucose Monitors and Components (receivers, sensors, transmitters, insulin pumps)

Covered by medical DME

For our policy on medical necessity criteria and prior authorization requirements for Continuous Glucose Monitors, visit our Clinical Review page and click the link to the CGM policy.

Insulin Pumps

OMNIPOD 5 DEXG7G6 INTRO GEN 5 KIT
OMNIPOD 5 DEXG7G6 PODS GEN 5 MISC

Blood Glucose Monitors and Test Strips

Covered by Pharmacy Benefit

Monitors

CONTOUR NEXT EZ KIT W/DEVICE 
CONTOUR NEXT LINK KIT W/DEVICE
PRODIGY BLOOD GLUCOSE MONITORING SYSTEM/TALKING MIS
ONETOUCH VERIO FLEX SYSTEM KIT W/DEVICE 

Test Strips

CONTOUR NEXT TEST STRP  
PRODIGY NO CODING BLOOD GLUC STRP  
ONETOUCH VERIO STRP 
ONETOUCH ULTRA STRP  
FREESTYLE TEST STRP  

Lancets/Syringes/Needles

Lancets

BD LANCET ULTRAFINE 30G MIS 30G
ONETOUCH DELICA PLUS LANCET33G MISC
ONETOUCH DELICA PLUS LANCET30G MISC 
PENLET II AUTOMATIC BLOODSAMPLER KIT BLOOD
FREESTYLE LANCETS MISC

Syringes

MONOJECT INSULIN SYRINGE MISC 27G X 1/2" 1 ML
MONOJECT INSULIN SYRINGE MISC 28G X 1/2" 0.5 ML
ULTICARE INSULIN SAFETY SYR MISC 29G X 1/2" 1 ML
ULTICARE INSULIN SAFETY SYR MISC 29G X 1/2" 0.5 ML
ULTIGUARD INSULIN SYRINGE/U-100/0.5ML/29G X 1/2" MIS 0.5/29G 
ULTIGUARD INSULIN SYRINGE/U-100/0.5ML/30G X 5/16" MIS 0.5/30G 
ULTICARE INSULIN SYRINGE MISC 29G X 1/2" 0.3 ML
ULTICARE INSULIN SYRINGE MISC 31G X 5/16" 1 ML
BD INSULIN SYRINGE MISC 29G X 1/2" 1 ML
BD SAFETYGLIDE INSULIN SYRINGE MISC 30G X 5/16" 0.5 ML
BD VEO INSULIN SYR ULTRAFINE MISC 31G X 15/64" 0.3 ML
BD VEO INSULIN SYR ULTRAFINE MISC 31G X 15/64" 0.5 ML
BD VEO INSULIN SYR ULTRAFINE MISC 31G X 15/64" 1 ML
BD VEO INSULIN SYR ULTRAFINE MISC 31G X 15/64" 0.3 ML
BD VEO INSULIN SYR U/F 1/2UNIT MISC 31G X 15/64" 0.3 ML
BD VEO INSULIN SYR ULTRAFINE MISC 31G X 15/64" 0.5 ML
BD VEO INSULIN SYR ULTRAFINE MISC 31G X 15/64" 1 ML
BD INSULIN SYRINGE U-500 MISC 31G X 6MM 0.5 ML
BD INSULIN SYRINGE MICROFINE IV/U-100/0.3ML/28G X 1/2" MIS 0.3/28G 
BD INSULIN SYRINGE ULTRAFINE MISC 30G X 1/2" 1 ML
BD INSULIN SYRINGE ULTRAFINE MISC 31G X 5/16" 1 ML
BD INSULIN SYRINGE MICROFINE/U-100/0.3ML/28G X 1/2" MIS 0.3/28G 
BD INSULIN SYRINGE ULTRAFINE MISC 30G X 1/2" 0.3 ML
BD INSULIN SYRINGE ULTRAFINE MISC 31G X 5/16" 0.3 ML
BD INSULIN SYRINGE ULTRAFINE MISC 30G X 1/2" 0.5 ML
BD INSULIN SYRINGE ULTRAFINE MISC 31G X 5/16" 0.5 ML
BD INSULIN SYRINGE MICROFINE MISC 27G X 5/8" 1 ML
BD INSULIN SYRINGE/DETACHABLE NEEDLE/U-100/1ML/25G X 1" MIS 1ML/25G 
BD INSULIN SYRINGE/DETACHABLE NEEDLE/U-100/1ML/26G X 1/2" MIS 1ML/26G
BD VEO INSULIN SYR ULTRAFINE MISC 31G X 15/64" 0.3 ML
BD VEO INSULIN SYR U/F 1/2UNIT MISC 31G X 15/64" 0.3 ML
BD INSULIN SYRINGE ULTRAFINE MISC 31G X 5/16" 0.3 ML
ULTRA-COMFORT INSULIN SYRINGE MISC 29G X 1/2" 0.3 ML
INSULIN SYRG MIS 0.3/31G 
COMFORT ASSIST INSULIN SYRINGE MISC 30G X 5/16" 1 ML
ULTRA COMFORT INSULIN SYRINGE/U-100/0.5ML/30G X 1/2" MIS 0.5/30G 
ULTRA COMFORT INSULIN SYRINGE/1ML/30G X 1/2" MIS 1ML/30G 
ULTRA COMFORT INSULIN SYRINGE/0.5ML/31G X 5/16" MIS 0.5/31G 
ULTRA COMFORT INSULIN SYRINGE/1ML/31G X 5/16" MIS 1ML/31G 
EASY TOUCH INSULIN SYRINGE MISC 28G X 1/2" 0.5 ML
SAFESNAP INSULIN SYRINGE/0.3ML/30G X 5/16" MIS 0.3/30G 
SAFESNAP INSULIN SYRINGE MISC 29G X 1/2" 0.5 ML
SAFESNAP INSULIN SYRINGE MISC 30G X 5/16" 0.5 ML
SAFESNAP INSULIN SYRINGE/1ML/28G X 1/2" MIS 1ML/28G 
SAFESNAP INSULIN SYRINGE MISC 29G X 1/2" 1 ML
MONOJECT INSULIN SYRINGE MISC 28G X 1/2" 0.5 ML
MONOJECT INSULIN SYRINGE MISC 25G X 5/8" 1 ML
MONOJECT INSULIN SYRINGE MISC 29G X 1/2" 1 ML
MONOJECT INSULIN SYRINGE MISC 30G X 5/16" 0.3 ML
MONOJECT ULTRA COMFORT SYRINGE MISC 28G X 1/2" 1 ML
MAGELLAN INSULIN SAFETY SYR MISC 29G X 1/2" 1 ML
MAGELLAN INSULIN SAFETY SYR MISC 29G X 1/2" 0.3 ML
MAGELLAN INSULIN SAFETY SYR MISC 29G X 1/2" 0.5 ML
MAGELLAN INSULIN SAFETY SYR MISC 30G X 5/16" 1 ML
MAGELLAN INSULIN SAFETY SYR MISC 30G X 5/16" 0.3 ML
MAGELLAN INSULIN SAFETY SYR MISC 30G X 5/16" 0.5 ML
TERUMO INSULIN SYRINGE/0.5ML/30G X 3/8" MIS 0.5/30G 
TERUMO INSULIN SYRINGE/1ML/30G X 3/8" MIS 1ML/30G 
THINPRO INSULIN SYRINGE/0.3ML/31G X 3/8" MIS 0.3/31G 
THINPRO INSULIN SYRINGE/1ML/31G X 3/8" MIS 1ML/31G
THINPRO INSULIN SYRINGE/0.5ML/31G X 3/8" MIS 0.5/31G 
THINPRO INSULIN SYRINGE/0.3ML/30G X 3/8" MIS 0.3/30G
TERUMO INSULIN SYRINGE/U-100/0.5ML/27G X 1/2" MIS 0.5/27G 
TERUMO INSULIN SYRINGE/0.25ML/29G X 1/2" MIS 0.25/29G
INSULIN SYRINGE MISC 29G X 1/2" 1 ML
INSULIN SYRINGE MISC 29G X 1/2" 0.3 ML
INSULIN SYRINGE MISC 30G X 5/16" 1 ML
LITETOUCH INSULIN SYRINGE MISC 28G X 1/2" 1 ML
INSULIN SYRINGE/U-100/1ML /28G X 1/2" MIS 1ML/28G 
INSULIN SYRINGE/U-100/1ML /29G X 1" MIS 1ML/29G 
INSULIN SYRINGE/U-100/1ML /30G X 1" MIS 1ML/30G 
INSULIN SYRINGE/U-100/1ML/29G X 1/2" MIS 1ML/29G
INSULIN SYRINGE/U-100/1ML /29G X 5/16" MIS 1ML/29G 
INSULIN SYRINGE/0.3ML/28G X 1" MIS 0.3/28G 
INSULIN SYRINGE/0.3ML/29G X 1" MIS 0.3/29G 
INSULIN SYRINGE/0.3ML/30G X 1" MIS 0.3/30G 
INSULIN SYRINGE/0.3ML/29G X 5/16" MIS 0.3/29G
INSULIN SYRINGE/0.5ML/28G X 1" MIS 0.5/28G
INSULIN SYRINGE/0.5ML/30G X 1" MIS 0.5/30G 
INSULIN SYRINGE/0.5ML/29G X 5/16" MIS 0.5/29G
ULTRA FLO INSULIN SYR 1/2 UNIT MISC 30G X 5/16" 0.3 ML
MINIMED SYRINGE RESERVOIR/3ML/22G X 1/2" MIS RES 3ML 
SURE COMFORT INSULIN SYRINGE MISC 29G X 1/2" 1 ML
GNP ULTRA COM INSULIN SYRINGE MISC 30G X 5/16" 0.3 ML

Needles

NOVOFINE PEN NEEDLE MISC 32G X 6 MM
NOVOFINE 30GX8MM MIS 30GX8MM 
NOVOFINE 31 MIS DISPOS  
NOVOFINE AUTOCOVER PEN NEEDLE MISC 30G X 8 MM

Medications

GLIPIZIDE 10MG TAB
GLIPIZIDE 5 MG TAB
METFORMIN 500MG ER TB
METFORMIN 750MG ER TB
METFORMIN 1000MG TAB
METFORMIN 500MG TAB
METFORMIN 850MG TAB
PIOGLITAZONE 15MG TAB
PIOGLITAZONE 30MG TAB
PIOGLITAZONE 45MG TAB
HUMULIN N SUSP 100 UNIT/ML VIAL
HUMULIN N SUSP 100 UNIT/ML VIAL
HUMULIN R SOLN 100 UNIT/ML VIAL
HUMULIN R SOLN 100 UNIT/ML VIAL
HUMULIN 70/30 SUSP (70-30) 100 UNIT/ML VIAL
HUMULIN 70/30 SUSP (70-30) 100 UNIT/ML VIAL
ONE TOUCH ULTRA TEST NFRS STRIP 50/BX
ONE TOUCH VERIO FLEX STARTER KIT 02404501 1/EA
ONE TOUCH VERIO LEVEL 3 (MID) CONTROL SOL 3.8ML
ONE TOUCH VERIO TEST STRIP BLUE 50/BX
ONETOUCH DELICA PLUS 30G LANCET 02401101 100/BX
ONETOUCH DELICA PLUS 33G LANCETS 100/BX
ONETOUCH VERIO STRIPS 100/BX

Where can I learn more about Prescription Drug benefits?

For a complete list of diabetic supplies that are available at the pharmacy, review the Mid-Atlantic States Marketplace Formulary. Visit our provider directory to find doctors and locations.

Where can I learn more about Durable Medical Equipment (DME) products?

Durable medical equipment (DME) and supplies like insulin pumps and glucose monitors are available through our vendors. Please contact your doctor or endocrinology specialist to discuss which devices and supplies you need. They can enter an authorization request for you. The vendor will then reach out to make sure you get the covered items you need.

Prior Authorization 

What if my diabetic supplies requires prior authorization?

If your plan requires prior authorization for a diabetic supply, your healthcare provider (doctor, nurse practitioner, etc.) will give us information about your diagnosis, treatment history and other relevant information to request prior authorization. If the prior authorization request is approved, you will pay a $0 cost share, not subject to a deductible.

How to request prior authorization for diabetic supplies

Patients

Your doctor will need to submit a prior authorization request.

Providers

Pharmacy Benefit: Please request prior authorization by completing and submitting the KPMAS HMO Medication Request Form to the KPMAS Pharmacy Authorization Service by faxing the form to 703-466-4999.

Medical Benefit: Please submit an online prior authorization request through UMOC: 

UMOC Main--800-810-4766 (weekends 301-960-1436)

FAX -1-800-660-2019