Continuous Subcutaneous Insulin External Infusion Pump - MEDICAID - LOUISIANA

This policy covers continuous subcutaneous insulin external infusion pumps and related supplies for treatment of Type I diabetes, including patients with wide glycemic fluctuations, recurrent severe hypoglycemia, microvascular complications, A1C above target (e.g., >7%), adolescents (including pregnant or with eating disorders), ketosis‑prone individuals, competitive athletes, and young children with extreme insulin sensitivity. Authorization requires meeting Criterion A (comprehensive diabetes education, ≥6 months of multiple daily injections with frequent dose adjustments and documented SMBG averaging ≥4 tests/day in the 2 months before initiation plus ≥2 specified criteria) or Criterion B (prior pump use with documented SMBG), demonstration of insulinopenia by fasting C‑peptide with concurrent fasting glucose <225 mg/dL, and ordering/follow‑up by a physician experienced in CSII who works with a diabetes care team; coverage is limited to Humana Healthy Horizons members in Louisiana.