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7% Saline Prescription and Medicare Part B payment quandry
MAC & Bronchiectasis | Last Active: Jul 25, 2023 | Replies (82)Comment receiving replies
Grrr! This should not be so difficult! Nor should CVS be allowed to be so stubborn and still participate in the Medicare program. Once again, as patients we need to be our own advocates. I have worked this out over the years with 4 Walgreens stores in 3 states.
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.
CVS Mail Order and Walgreens have both filled my 3% and 7% orders, though sometimes Walgreens must order in the 7% from their warehouse or supplier.
I have found the best way to handle this is with this document in hand, first in the doctor's office, then at the pharmacy. I wouldn't bother if it was a one time thing, but having the Rx covered saves me $30-50 a month, which is not small change.
Sue
Replies to "Grrr! This should not be so difficult! Nor should CVS be allowed to be so stubborn..."
Does Medicare cover PulmoSal (buffered 7% saline)? That is the only kind that my pulmonologist will prescribe because it is gentler on the lungs. I've been paying over $50 out of pocket because my pharmacy (independent, not part of a chain) told me that it is not covered by Medicare or my pharmacy plan, but I'm definitely going to show them what you posted.
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@sueinmn Does this also apply to antibiotics used in a nebulizer? I have been using Colistin (colistimethate sodium) for just over a year. It has been the only antibiotic that has kept me symptom free from pseudomonas. Previously I was on several different oral antibiotics, then on Tobramycin and Cayston both of which were nebulized. Insurance paid in full for Tobramycin. Cayston was not and very expensive. Eventually I asked to switch back to the free Tobramycin as Cayston was not helping my symptoms and it was breaking my bank account. So at that point I was prescribed Colistin. I recently changed my part D prescription coverage and now the Colistin is much more expensive even though I called the company before signing up with them and they told me a cost ($400 for a 90 day supply) that was a lot less expensive than what I had been paying so I changed. I had my prescription sent to a preferred pharmacy and they said it would be $400 per 30 day supply. If this medication is nebulized, shouldn’t it fall under what you are describing? I’m very frustrated as this is too expensive, but not sure what my next step should be. By the way I tried Good Rx and no help. (I have bronchiectasis, pseudomonas aeruginosa, and a history of MAC).
Any advice is welcome! Thank you.