Notable Changes for Diabetic Patients
Starting Jan. 1, 2025, there are two changes to be aware of that affect your patients with diabetes.
Upon issuance or renewal, prescription insulin will be covered with $0 cost-share. This applies to all New York commercial plans including Essential Plan, individual and family plans, and small and large group plans.
Copayments, coinsurance, and deductibles will be waived for members with a diabetes diagnosis who have an Essential Plan or an individual or family plan (excluding the Catastrophic plan) through the NY State of Health, for the following:
- Primary care office visits for the diagnosis, management, and treatment of diabetes.
- One office visit to perform an annual dilated retinal examination.
- One office visit to perform an annual diabetic foot exam.
- Diabetic self-management education services.
- Laboratory procedures and tests for the diagnosis and management of diabetes.
- Diabetic equipment and related supplies for the treatment of diabetes when prescribed by you or another provider who is legally authorized to prescribe including:
- Acetone reagent strips.
- Acetone reagent tablets.
- Alcohol or peroxide by the pint.
- Alcohol wipes.
- All insulin preparations.
- Automatic blood lance kit.
- Cartridges for the visually impaired.
- Diabetes data management systems.
- Disposable insulin and pen cartridges.
- Drawing-up devices for the visually impaired.
- Equipment for use of the pump including batteries.
- Glucagon for injection to increase blood glucose concentration.
- Glucose acetone reagent strips.
- Glucose kit.
- Glucose monitor (with or without special features for visually impaired), control solutions, and strips for home glucose monitor.
- Glucose reagent tape.
- Glucose test or reagent strips.
- Injection aides.
- Injector (Busher) automatic.
- Insulin cartridge delivery.
- Insulin infusion devices.
- Insulin pump.
- Lancets.
- Oral agents such as glucose tablets and gels.
- Oral anti-diabetic agents used to reduce blood sugar levels.
- Syringe with needle; sterile 1 cc box.
- Urine testing products for glucose and ketones.
- Additional supplies, as the New York State Commissioner of Health shall designate by regulation as appropriate for the treatment of diabetes.
Note: Cost-sharing may apply to other services provided during the same visit as diabetic services.
Notable Changes Pregnant and Postpartum Members
Beginning Jan. 1, 2025, pregnant and postpartum members who have individual and family plans (excluding the Catastrophic plan) through the NY State of Health will have copayments, coinsurance, and deductibles waived for:
- Prescription drugs.
- Urgent care services.
- Outpatient mental health services.
- Outpatient substance use services including partial hospitalization program services.
- All services listed under preventive care.
- All services and items listed under additional benefits, such as equipment and devices.
- Outpatient services.
- Professional services.
Cost-sharing will still apply to:
- Inpatient hospital and birthing center services for delivery.
- All inpatient services (e.g., hospital, rehabilitation, mental health/substance use disorder, and hospice).
- Emergency care in a hospital.
- Physician, nurse practitioner, and midwife services for delivery.
- Ambulance services.Pediatric vision and dental services for covered services.
Cost-sharing for all services has been waived for pregnant and postpartum Essential Plan members since April 4, 2024.
*Postpartum is defined as 12 months after delivery or other ending of pregnancy.
JP68152 01/2025