3% Saline vs. 7% for Nebulizing

I have been nebulizing with albuterol/Ipratropium and Budesonide twice daily since 2020. I have MAC and Bronchiectasis. I just had a CT scan and it compares favorably with previous scans indicating my condition is not worsening. At this appointment, my doctor added 3% saline to my neb routine. I checked GoodRx for best price since it is not covered by Medicare. It looks like I can get 180 vials 4ml of 3% sodium chloride for $33 at Walgreens.

@chisintexas It is my understanding that the saline is covered under Medicare Part B (Not part D) but your doctor must code it as durable medical equipment. I will find out soon enough as I am now on Medicare effective May 1!

@chisintexas That’s a good price! Last year I paid $22 for an mos supply. This year it went up to $48 for same amount with Good RX. I’ve tried many ways to get it through my Medicare but still comes back not covered.

@speeched100 My reply was meant for Chrisintexas.

@chisintexas MEDICARE covered mine. I have an advantage plan that covers doctors, prescriptions, vision and dental at no extra cost.

I discussed the use of 3% vs. 7% saline with my pulmonologist, Dr. Margaret Johnson at Mayo Clinic in Jacksonville. My voice had become very raspy and I sing with a small chorus. . She felt that since there have not been any studies to see if it made a difference, I could try it. My singing voice has improved dramatically and I am going to continue to use 3% unless I start producing a lot of mucus. I have been on Brinsupri for 6 months which has significantly reduced the amount of mucus coughed up. However, that being said, I seem to remember that 7% was the recommended dose because of the higher salt content having more therapeutic effects. Each of us is different and the most important thing is that we do airway clearance.

@mjb24
Will you post and let me know if it is covered and what kind of results you have using it?

Medicare does not cover any of the salines that I have ever submitted to them. I don't know why they would cover it for some people and not others. I do not have a supplement plan.

@beejenigma I'll try to explain why, based on lengthy study of the Medicare rules and a long discussion with my excellent independent pharmacist about how it all works.

Any medication dispensed via durable medical equipment (nebulizer) is covered by Medicare Part B. Many pharmacies seem to not be aware of this, and try to submit to Part D, which always rejects. (It seems that not every pharmacy is enrolled to dispense under Medicare Part B, but this is my impression.)

Saline nebs are considered an "adjunct treatment" not a medication. So if you have been prescribed a nebulizer and an inhaled prescription medication, when saline is also prescribed it can be covered. The pharmacy must code the bill correctly and submit to Medicare Part B. It also helps if the prescription for the nebulizer is in your Medicare records.

If you do not have any prescribed nebulized medications, it is unlikely Medicare will cover the saline. However, if you already use a prescription inhaler for your lungs, if the doctor prescribes the inhaled version of the same drug, then the saline, it will be covered. My doc did this - I normally only use an inhaler, but I have an "on hand" nebulized version of the same, for use during an exacerbation.

For those with a Medicare supplement that includes a monthly or quarterly allowance for over-the-counter FSA eligible products, the saline solution meets the requirement.

@hopeful33250 @beejenigma @sueinmn I just went through getting my prescription for 7% saline from my usual pharmacy (Publix). They did submit to Medicare Part B and told me it was declined. I went home and called Medicare. I must say, I had no problem getting through and they were very helpful. They confirmed that it is covered under part b and called my pharmacy with me on the line to find out why it wasn't going through. It turns out Medicare covers it but Publix will not accept the Medicare payment for this prescription. I called several pharmacies and they all told me the same thing. Finally I called Walgreens and they told me they do accept part b. I am having my prescription transferred and will see if it actually goes through. So, it seems your doctor does need to code it as durable medical equipment but you also need to find a pharmacy that will accept part b. Whew, what a battle...for salt water! Imagine, no problem getting all of these other toxic medications but salt water is a hassle!