7% Saline Prescription and Medicare Part B payment quandry

I had this problem a few years ago. All nebulized drugs should be referenced as durable medical equipment that is purchased at the pharmacy. Never refer to it as a prescription drug. It's always DME that you have to get at the pharmacy. I had to call Medicare to understand the correct verbiage, then called the person at my doctors office who handled insurance stuff and gave her that exact info and we were able to get it done. The nebulizing equipment itself was not covered for me. @lindam272

For those of you who are getting the saline through Medicare part B, is there a copay?
I just confirmed with my insurance that they will cover a 30 day supply with a copay of $10.00. My local CVS will not bill Medicare part B, but told me Rite Aid will — doable but not quite as convenient.
Anna

Yes, I have a copay, however my specific BCBS policy covers it . My neighbor has a different BCBS policy and has a 20% copay on $56, or $11.20 per 60 vials.

Success! I just went through this in the past week. My doctor sent a prescription for 7% Saline to my local pharmacy. They tried several ways to get it approved and could not. I remembered reading an earlier post on this site regarding this issue. Medicare Part B does cover saline for nebulization, but it must be submitted specifically under the DME (Durable Medical Equipment) section under Part B. I told my pharmacy about this and they informed me they work with Part B - but not the DME part, as they do not supply other DME items, such as nebulizers.
I then had my prescription transferred to a pharmacy that supplies meds and DME items and -Success - the saline was approved under my Medicare Part B - DME coverage.
I hope this is helpful and others who have hit similar roadblocks find success as well!

Please tell your neighbor about GoodRx. It is so easy to use and I paid $18 for 180 vials! Donna

Well, I am more confused than ever. My doctor sent in prescriptions to CVS for the Saline Solution and Albuterol Solution. I’ve had trouble for at least a year getting Medicare to consistently pay for both or either. At times, all is fine. Then it’s not. Today it wasn’t, again! I was told last year that Medicare Part D was how Medicare would pay. Well, today, CVS told me it had to be Part B, and that my doctor had not coded the prescription correctly. I can’t tell you how often I worked with my doctor’s office last year to get all of that straight. Add in the supply chain issues and back orders. I came home without what I needed, but with a promise that they’d deliver it tomorrow. But, I paid full price. Grrr. I’m not sure why pharmacies and Medicare haven’t gotten this worked out. I certainly am not the only person in this situation. No one seems to know the answer and I get a lot of shoulder shrugs from too many people.

Please let me reiterate - if the doctor codes it wrong, the pharmacist cannot change them - it is not in their purview. In the "olden days" the really good pharmacists would call the doctor/clinic and explain. Then the doc would Fax a revised Rx, all would be good.

Fast forward to 2023 - understaffing, inexperience, lack of training, everything goes to voicemail...All of these are REAL issues. My local pharmacy used to have one full time and 3 part time pharmacists, 6 pharm techs and were open 12 hours a day, 7 days a week. Now the full time pharmacist has one occasional part-timer and 4 pharm techs and they are open 9 hours a day, 6 days a week.
My primary care provider watched her patient load balloon from 1500 to 3000 patients, lost her 2 RNs (replaced by 2 medical assistants) - and she QUIT!

Staff training? How, when and who can do it? And who will train their replacements in one-three-six months? Medicare and insurance providers are as frustrated as we are.

I am not trying to be an apologist, but only to point out what we all know - something is broken. The best way to help ourselves at this point is to take the document I cited above (https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=52466 ) with you to the doctor's office and the pharmacy, with the items relevant to you highlighted.
Sue

Newbie - I just got off the phone with Medicare part b regarding the 3% solution. At the moment according to a site I am not allowed to list (google drug shortages) there are shortages of the 7 and 3 % etc solutions. I have not found a single pharmacy near me who have it or can get it (the 3% 4 ml size). I was able to find a supplier but it would be extremely costly to buy every month and so I asked medicare part b if they could retroactively cover it and they said no. You have to buy from a company that accepts Medicare. The site I listed above will show suppliers that may have what you need but they are unlikely to take medicare. This is a big problem.

After countless calls to both Medicare, BC/BS, and others, I've given up. I did file a complaint with Medicare and will, as suggested by another contributor, send a complaint to Iowa senator Charles Grassley. The last pharmacist I spoke with today had a direct number to a Medicare contact for pharmacists. Contrary to what I had been told by 3 Medicare reps, this pharmacist was told it was NOT covered under either of the diagnostic codes our pulmonologist used - the first for bronchiectasis; the second attempt for COPD. She didn't know how to file it with BC/BS. Buying it over the counter was $279/60 vials! Really? A GoodRx card was 10% of that cost, but I just want a consistent provider at a fair price. It appears that almost no pharmacy has it in stock anyway and most can't even currently get it from their distributors. Supply chain issue? I have emailed our pulmonologist about the possibility of making my own in small sterile bottles. After all, this is only sterilized salt water. Anyone else discussed taking a homemade saline approach with their pulmonologist? I know, I know. One must be careful what one puts in one's lungs, but there are countless known toxins out there that damage lungs etc., secondary smoke, radon, asbestos, air pollution.
Elle

I live in Iowa. I get my 7% saline from my local Hy Vee Pharmacy. My Dr made some sort of prescription for it but I do not know the details of what he submitted. I do not have Part D and never knew this could be covered by Part B and so I have to pay for it but they use a coupon and it is only about $25 for a box of 60. So I have no idea why you should be charged $279! That is crazy expensive. So far there has been no shortage but hopefully will not be when I reorder it.