Does Medicare Part B cover sodium chloride solution?

Posted by lora jo @ljfoo, Mar 23, 2022

CVS says that neither Medicare Part D nor Medicare Part B covers the 3% or 7% sodium chloride I need. I've read on this discussion group that some of you have been able to get your sodium chloride covered by Medicare Part B. How did you do that? Is there a specific Diagnosis Code that your doctor has given your pharmacy? Can you ask your doctor what that code is? My pulmonologist is having a hard time figuring this out also.
lora jo

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My doctor's office has been talking to the Walgreens pharmacist but that pharmacist doesn't seem to know how to get Medicare B to cover the sodium chloride. Maybe your pharmacist can talk to my pharmacist?

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In reply to @ljfoo… the pharmacist was Emily (but I don’t know if she still works there, but if she does, she might be willing to do it) and the phone #218-751-1730. Good luck!

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Thanks! I'll give it a try.
lora jo

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@migizii

In reply to @ljfoo … in my case, it took a number of attempts to get the 7% solution covered by pt. B. What ended up resolving the issue was having the pharmacist call my pulmonologist’s office and walk them through how to submit the script in the way needed for Medicare. It finally worked and has worked for the past two years now! This is another idea to try. Good luck!

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Hi all - this is somewhat of an old thread but I started having issues with Walgreens this year - after years of smooth sailing getting the 7% solution covered by Medicare. Walgreens insisted that Medicare only covered a specific generic version made by Nephron but I was told elsewhere that I needed something like albuterol in order for it to be covered. It seems there is a shortage of the Nephron version as well.
I am wondering if anyone else is having this issue and if they were able to solve it.
Mary

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@sayaboleh

Hi all - this is somewhat of an old thread but I started having issues with Walgreens this year - after years of smooth sailing getting the 7% solution covered by Medicare. Walgreens insisted that Medicare only covered a specific generic version made by Nephron but I was told elsewhere that I needed something like albuterol in order for it to be covered. It seems there is a shortage of the Nephron version as well.
I am wondering if anyone else is having this issue and if they were able to solve it.
Mary

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No problem recently with them, I do not get my Levalbuterol Rx through them, so I fear that is yet another misunderstanding of the rules...
They fill with whatever generic version is available to them - even filled with Pulmosal one time.
Sue

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@sueinmn

No problem recently with them, I do not get my Levalbuterol Rx through them, so I fear that is yet another misunderstanding of the rules...
They fill with whatever generic version is available to them - even filled with Pulmosal one time.
Sue

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Hi Sue
Do you mind sharing where you get yours filled? Do you mind if I contact them to ask how they are doing it to go through without the gyrations?
Thanks!
Mary

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@sayaboleh

Hi Sue
Do you mind sharing where you get yours filled? Do you mind if I contact them to ask how they are doing it to go through without the gyrations?
Thanks!
Mary

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Here is the link I previously posted:
Here is the info from Medicare:
https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=52466
Medicare Part B covers nebulizer as durable medical equipment, and solutions as supplies. The doctor must provide the proper diagnostic codes. The pharmacy must enter them, and state whether it is the initial nebulizer Rx because they get a dispensing fee, or a subsequent order.
ALL licensed pharmacies that dispense nebulizers and accept Medicare are able to do this, they may need to be TAUGHT how.

I am sorry, but my poor pharmacist is so overworked these days due to staff shortages that I do not feel comfortable sharing his contact info and adding to his workload.
Sue

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@sueinmn

Here is the link I previously posted:
Here is the info from Medicare:
https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=52466
Medicare Part B covers nebulizer as durable medical equipment, and solutions as supplies. The doctor must provide the proper diagnostic codes. The pharmacy must enter them, and state whether it is the initial nebulizer Rx because they get a dispensing fee, or a subsequent order.
ALL licensed pharmacies that dispense nebulizers and accept Medicare are able to do this, they may need to be TAUGHT how.

I am sorry, but my poor pharmacist is so overworked these days due to staff shortages that I do not feel comfortable sharing his contact info and adding to his workload.
Sue

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I totally understand but can you share which pharmacy at least? Walgreens? I suspect that Walgreens needs to have my initial nebulizer Rx which may have been dropped off. They are also overworked and are probably a little annoyed with me!

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@sayaboleh

I totally understand but can you share which pharmacy at least? Walgreens? I suspect that Walgreens needs to have my initial nebulizer Rx which may have been dropped off. They are also overworked and are probably a little annoyed with me!

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My local CVS, a very small pharmacy, tells me that since they don't dispense nebulizers or any other equipment covered under Part B, they can't (won't?) get coverage for my saline under Part B. Fortunately, my supplemental covers with a $10 copay.
Anna

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@sayaboleh

I totally understand but can you share which pharmacy at least? Walgreens? I suspect that Walgreens needs to have my initial nebulizer Rx which may have been dropped off. They are also overworked and are probably a little annoyed with me!

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Walgreens. I have also used local independent pharmacies in Minnesota and Texas.
Sue

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