7% Saline Prescription and Medicare Part B payment quandry

I will be most interested to hear more about this. I'm two weeks into nebulizing 7% saline for my MAC PT protocols. Paid out of pocket $35 but would love to know if there is any chance of this being covered. Thanks for asking the question!

After numerous calls, I find this search for information to be a frustrating exercise in bureaucracy. Apparently, what diagnostic code is used by the physician and pharmacist matters. One pharmacist said Medicare Plan B seems to only cover if the diagnosis is COPD. I am following up on this. Also, I filed a complaint with Medicare. Why should anyone have to spend several hundred dollars a year for 7% saline if it should be covered by Medicare Plan B?! I'll post what I learn. Note: CVS said people use GoodRX discount cards all the time and the price now is $12/month. I've never used this card before, but I may try it. Elle

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

I have had this problem off and on with CVS regarding saline and more recently with Walmart pharmacy for albuterol for the nebulizer. Both have turned out to be a coding problem and require my pulmonologist to be very clear that my diagnosis ( bronchiectasis) requires these medications through part B. This problem is now compounded due to shortages for both prescriptions. I’ve recently been getting saline out of pocket.

I was told by medicare NOT all pharmacies will accept part B and that we should call Medicare to find which pharmacies in your area will accept it. But according to the representative I talked to, it should be covered. I too was paying OOP and frustrated. I just talked to Medicare yesterday, so I will go to the pharmacies they recommend in my area and see how it goes. Really glad that @ellenholm did research on it too with a Medicare rep. We have to petition together! ICD 10 Number is very important for their billing. Goodrx isn't through medicare and we may get a better price through Medicare? Medicare told me to try CVS but also my local healthcare facility since they sell DME's there and the sodium chloride is considered a DME (durable medical equipment). Hope that helps!

@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.

These questions might be answered by the document I cited. I got a similar "nasty surprise" when one of my meds (a specialty inhaler) was removed from the regular formulary to the specialty pharmacy between 2021 & 2022.
Sorry, but it isn't something I am familiar with.
Sue

I have the same problem, and have for about a year. I think it’s because Medicare changed its rules about this coverage. I believe they no longer cover the saline under Part B. It’s now under Part D. I’ve had a hard time getting the saline from CVS off and on. They have had trouble getting the solution. So, I went to a compounding pharmacy, but they do not take Medicare. Thus, I’m paying much more for saline than I did before. It’s confusing and frustrating.

I have also tried with no success to get saline vials covered by Medicare. I have been given so many different answers by pharmacists, Lincare, Medicare, etc. One Medicare rep. that I spoke with on the phone last summer told me that it is covered under Part B, but in my area, only at Lincare and CVS. Pharmacists at both places told me that it is NOT. I tried calling Medicare again recently. The first person I spoke with tried to convince me that drugs are covered under Part D, not B! Unfortunately, their employees are not being trained. The next Medicare rep. I talked with was unsure, but did take the time to do some research and said that she thought it is covered. I have pretty much given up and use a GoodRx coupon. I purchased 180 vials of 7% saline for about $18. I will continue to follow replies to this issue to learn how others have succeeded. Donna

So where does the problem lie? With Medicare or the pharmacies? NTMir maybe able to help petition Medicare, but...Medicare told me that any chronic lung condition, the inhalent medications should be covered. Suggestions on how to fix this? You think copying this thread and sending it to your state health department or senator?