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BCBS NC | Covered NDCs - BP Monitor & HbA1c Test Kits

Coverage information for BP & HbA1c Test Kits

Max Anderegg avatar
Written by Max Anderegg
Updated over a week ago

πŸ“Œ Note | Beginning 5/1/2024 BCNC will be covering A1c test kits and BP cuffs for members under our Enhanced and Essential formularies .

See information below about methods to identify which members are covered under the Enhanced and Essential formularies.

Prescription Coverage Details

  • A prescription is required for coverage (see attached files to access prescription request forms)

    • HTN Prescription Request Provider Communication

    • DM Prescription Request Provider Communication

  • Covered NDCs are included in the attached file BCBS NC Covered NDCs

  • The day supply must be entered as 30 days.

  • Quantity limits (QL)

    • A1c tests will have a QL of 2 tests per 180 days

    • BP cuffs will have a QL of 1 cuff per 365 days.

Patient Eligibility Details

You can determine if a member is covered by one of the formularies by looking in the bottom, right corner of their Blue Cross NC ID card.

If a member is covered by one of the Enhanced or Essential formularies, the circled area on the example ID card above corresponds to column one of the table below.

ID Card Codes

Plan Description

Plan Shorthand

N/A or Exclude

Exclude

E

Rx A2 or 2A

Enhanced 4 Tier Commercial

Broad Network

Enhanced 4

Tier C

Rx B2 or 2B

Enhanced 5 Tier Commercial

Broad Network

Enhanced 5

Tier C

Rx A4 or 4A

Enhanced 4 Tier Commercial

Limited NC Network

Enhanced 4

Tier C

Rx B4 or 4B

Enhanced 5 Tier Commercial

Limited NC Network

Enhanced 5

Tier C

Rx C4 of 4C

Essential Commercial

Limited NC Network

Essential C

Rx C2 or 2C

Essential Commercial

Broad Network

Essential C

Rx D4 or 4D

Essential QHP

Limited NC Network

Essential Q

Rx D2 or 2D

Essential QHP

Broad Network

Essential Q

Rx E4 or 4E

NetResults 5 Tier Commercial

Limited NC Network

NetResults 5

Tier C

Rx A5 or 5A

Enhanced 4 Tier Commercial,

Limited National Network

Enhanced 4

Tier C

Rx B5 or 5B

Enhanced 5 Tier Commercial

Limited National Network

Enhanced 5

Tier C

Rx C5 or 5C

Essential Commercial,

Limited National Network

Essential C

Rx E5 or 5E

NetResults 5 Tier Commercial

Limited National Network

NetResults 5

Tier C

Rx A3 or 3A

Enhanced 4 Tier C

Broad Plus Network

Enhanced 4

Tier C

Rx B3 or 3B

Enhanced 5 Tier C

Broad Plus Network

Enhanced 5

Tier C

Rx C3 or 3C

Essential Commercial

Broad Plus Network

Essential C

Rx E3 or 3E

NetResults 5 Tier C

Broad Plus Network

NetResults 5

Tier C

Rx F4 or 4F

Essential QS

Limited NC Network

Essential QS


Resource Files

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