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7% Saline Prescription and Medicare Part B payment quandry
My husband is 81, diagnosed with MAC, and has been on the 3-drug regimen for 2.5 weeks. He uses a nebulizer 2XDay with 7% saline.
Problem: Humana won't cover the saline prescription because they say it is covered under Medicare Part B. But, when filling the saline prescription the pharmacist can't get Medicare Part B to work. Our secondary (not supplemental) health insurance Blue Cross/Blue Shield says (thinks?) it needs to be coded as a durable medical, which neither CVS nor Medicap will use. (It seems to me that while the nebulizer is a durable medical; the saline is more a prescription.) In the meantime, we are paying out-of-pocket for a saline prescription the pulmonologist and all others say should be covered under Medicare Part B. Anyone else had this experience? How was it resolved? Many thanks!
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Welcome newbie @liz440 🙂
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- Drug Shortages: 8/31/2022 Sodium Chloride Inhalation Solution https://www.ashp.org/drug-shortages/current-shortages/drug-shortage-detail.aspx?id=791&loginreturnUrl=SSOCheckOnly
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1 ReactionDoes 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.
The short answer is maybe. Part D prescriptions are very cut and dried - there is a formulary, and it is almost impossible to get them to deviate. Part B exceptions are a different - it is dependent on the request for deviation as written by your physician.
Sue
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1 ReactionI use PulmoSal and my pharmacy charges around $25 a box by using some sort of coupon.
New to this support group; not new to MAC. Not to get off the subject, but does anyone use albuterol versus saline? My pulmonologist prescribed albuterol, and I ordered saline on Amazon for about $19 for a box of 25. The saline wasn't for me. I am finally getting over the after affects of albuterol such as shaky hands and a light head. thanks!
Irenea8, can you tell me what kind of coupon? That would be very helpful.
I do not know. My pharmacy is very helpful and always looks up coupons for any prescription and then applies them. Probably something like good RX??
When I was diagnosed with MAC a year and half ago, my pulmonologist recommended nebulizing with albuterol AND then 7% saline twice a day. It was not an either/or. Friends in a support group suggested waiting 10 minutes after the albuterol to do the saline. I’ve had the same effects as you (jittery, etc) from albuterol and stopped using it in the evening as sometimes I was too jazzed up to sleep. She didn’t like this and then prescribed levalbuteral with is a little better but I still don’t use late in the evening but always use the saline twice a day. Albuterol opens up the airways but saline thins the mucus to help get it out. Some also say the saline makes it hard for the MAC to flourish.
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3 ReactionsThank you very much. I have learned a lot from reading all the posts from this support group. Your comment about saline thinning the mucus makes sense and saline making it hard for the MAC to flourish is a good reason for me to start adding it to my daily routine!
Here’s what I found by “googling”.
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