If you are currently enrolled in the Ballad Health Diabetes Management Program, you do not need to re-enroll for the FY20 plan year; your enrollment in the program continues.
However, you must participate in the Ballad Health wellness program as the primary insured regardless of the medical plan chosen if you, your spouse, or dependent children wish to participate in the program.
You can find more information about the Diabetes Management Program, including a list of the diabetes medications covered by the program, on the Ballad Health Wellness Page on the intranet.
How to enroll
- You and/or your spouse/dependent can enroll in the program by calling 1-888-314-7803.
Eligibility for Diabetes Management Program
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Must be enrolled in a Ballad Health plan |
Must participate in wellness program |
Required affirmation of diagnosis |
| Team member only | Team member | Team member | Team member |
| Team member’s spouse | Both team member & spouse | Both team member & spouse | Spouse |
| Team member’s dependent child | Both team member & dependent child | Team member | Dependent child |
Participation Criteria
- Must be enrolled in the Ballad Health wellness program regardless of the benefit plan you participate in.
- One HgbA1c yearly (provided for free as part of the wellness screenings)
- Participate in coaching sessions with a diabetes coach every three months
- Complete a visit with the clinical pharmacist annually (this counts as one coaching session)
- Complete an annual diabetic eye exam. (*If there is no evidence of retinopathy at one or more annual eye exams, then exams every two years may be considered. If any level of diabetic retinopathy is present, subsequent dilated retinal examination should be repeated at least annually by an ophthalmologist or optometrist.)
- Complete an annual provider visit.
Diabetes Coaching
What are the ways I can complete my pharmacy visit and coaching sessions?
Diabetes coaching and pharmacy sessions can be completed by telephone and/or in person.
Will my primary care doctor or endocrinologist be given a copy of my lab results?
Yes, we will share your lab results with your healthcare team including your primary care doctor so your healthcare team can provide, coordinate, and manage your health care and related services.
Will my personal information be kept private?
Yes, we will maintain the confidentiality of your protected health information and only use it in a manner that protects your privacy and complies with the Health Insurance and Portability and Accountability Act (HIPAA) and any other applicable laws. Ballad Health’s employer-sponsored plan will not receive your results in any form that match the data to you, though they may receive de-identified, aggregated data from the entire population of participating team members.
Medication & Supplies
Where are the Ballad Health’s pharmacy locations?
| Tennessee | Virginia |
| 523 State of Franklin Road Johnson City, TN 37604 Phone: (423) 926-6154 Fax: (423) 926-5571 Business Hours: 9 a.m. – 7 p.m., Monday – Friday 9 a.m. – 3 p.m., Saturday Closed – Sunday |
Located in the HealthPlex 1490 Park Ave NW, Ste 7 Norton, VA 24273 Phone: (276) 439-1360 Fax: (276) 439-1305 Business Hours: 9 a.m. – 5:30 p.m., Monday – Friday Closed – Saturday & Sunday |
| Located in the Johnson City Medical Center Lobby 400 N. State of Franklin Road Johnson City, TN 37604 Phone: (423) 431-2140 Fax: (423) 431-2144 Business Hours: 9 a.m. – 7 p.m., Monday – Friday 10 a.m. – 6 p.m. Saturday 11 a.m. – 5 p.m. Sunday |
Located in the Cancer Center Lobby 16000 Johnston Memorial Drive Abingdon, VA 24211 Phone: (276) 258-1990 Fax: (276) 258-1999 Business Hours: 9 a.m. – 6 p.m., Monday – Friday 9 am – 3 p.m., Saturday & Sunday |
| 1657 East Stone Drive Kingsport, TN 37660 Phone: (423) 247-2126 Fax: (423) 247-2138 Business Hours: 9 a.m. to 6 p.m., Monday – Friday 9 a.m. to 3 p.m., Saturday Closed – Sunday |
Coming soon:
350 Blountville Highway Bristol, TN Phone (423) 844-5490 Business Hours: |
These locations aren’t convenient for me. Are there other options to obtain my diabetic medications?
- Your medications can be delivered to all Ballad Health hospital inpatient pharmacy locations, except Holston Valley Medical Center (Kingsport) and Bristol Regional Medical Center (Bristol, Tenn.).
- Your medications can be delivered to your home or work if you live in Kingsport or Johnson City (with the exception of Holston Valley Medical Center).
- Your medications can be mailed to your home regardless of where you live.
How do I know what medications are covered?
A complete list of covered medications can be found on the benefits page on the Ballad Health intranet.
Will my medications and supplies be provided at no out-of-pocket cost to me?
All medications and supplies on the OptumRx Diabetes Management Program Prescription List will be fully paid by Ballad Health and therefore have zero ($0) copay to program participants. In order to take advantage of this benefit, medications must be filled at a Ballad Health’s pharmacy. If filled at other pharmacies, cost will apply to deductible and then coinsurance applied.
Are insulin pumps, supplies or glucose testing strips included?
- Yes, insulin pumps will be fully paid by Ballad Health through the medical plan subject to plan limitations. Your endocrinologist will help with billing to the device manufacturer.
- Yes, pump supplies (ex: tubing, reservoirs, sensors that correspond with the pump) will be fully paid by Ballad Health through the medical plan and therefore have no out-of-pocket cost for program participants. Medtronic supplies can be obtained through Mountain States Infusion pharmacy. Omnipod and Tandem supplies can be obtained through your current vendor.
- Yes, glucose testing strips required to communicate with your pump also have a zero out-of-pocket cost through your drug benefit. These can be obtained through any of the five (soon to be six) Ballad Health retail pharmacy locations. Please allow extra time for the pharmacy to work with HR to obtain an override from Optum.
How much medication supply can I get at one time?
Up to a 90-day supply
Do I need to change glucometers?
The approved glucometers are the OneTouch Verio Meter, OneTouch Verio Flex Meter and OneTouch IQ Meter. These meters are provided by OptumRx at no cost to the plan. The program participant must call OneTouch customer service to request this glucometer. If filed through the Rx plan, it is not covered. The number for OneTouch Meter is 1-866-355-9962. Order code 594PRX100.
Help! My medications are not covered. What should I do?
- Contact the Ballad Health’s pharmacy location closest to your location. They will contact your physician on your behalf to obtain a prescription for a covered alternative. Note: Some physician practices are very busy. Please contact one of our pharmacy staff as soon as possible to start this process. If prior authorization is approved, it may be at $0 copay or it may be subject to copay and deductibles (not 100% your cost). Your Ballad Health pharmacist will help you.
- Note: The below list of excluded medications means these medications you will have to pay 100% and will NOT apply to your deductible. Also note: some of the preferred alternatives are NOT on the diabetes program at zero cost, but are a covered benefit under your drug plan subject to copays and deductibles. Ex: Tresiba.
| Therapeutic Category | Excluded Medications | Preferred Alternatives |
| Diabetes
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| Blood Glucose Meters, Test Strips and Control Solution | Examples: Abbott (Freestyle, Precision, Arkray (Glucocard), Bayer (Breeze, Contour), Nipro (TRUEtest, TRUEtrack), Roche (Accu-check) | Lifescan (One Touch Products) |
| Blood Sugar Regulators Miscellaneous | Metformin, HCL 24hrER osmotic release, Metformin HCL 24hr ER modified release | Metformin ER (generic GLUCOPHAGE XR) |
| Dipeptidyl Peptidase -4 (DPP4) Inhibitors and Combinations | Alogliptin (M), Alogliptin with metformin (M), alogliptin with pioglitazone (M), Kazono, Kombiglyze XR, Nesina, Onglyza, Oseni | Janumet, Janumet XR, Januvia, Jentadueto, Jentadueto XR, Tradjenta |
| Basal Insulin
|
Basaglar, Levemir, Tresiba | Lantus, Toujeo |
| Glucagon-Like Peptide -1 (GLP1) Agonist
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Adlyxin, Tanzeum | BYdureon, Bydureon Bcise, Byetta, Ozempic, Trulicity, Victoza |
| Insulins
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Novolin | Humulin |
| Rapid Acting Insulin
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Admeolg, Apidra, Fiasip, Novolog | Humalog |
| Sodium-glucose co-transporter (SGLT2) inhibitors | Farxiga, Segiuromet, Steglatro, Xigduo XR | Invokamet, Invokamet XR, Invokana, Jardiance, Synjardy, Synjardy XR |
| SGLT and DPP4 Combinations | Qtern, Steglujan | Glyxambi |