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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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I have had issues with Publix Pharmacy trying to get Sodium Chloride covered with Medicare and they have been so good about using coupons whenever I have to re-order. The Pharmacy you use should have a coupon they can use to help with the cost.
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1 ReactionThe only pharmacy in my area that claims they can get sodium chloride 3% does not accept coupons but will bill medicare. However, they claim that medicare part b will only cover sodium chloride 3% if mixed with something else. I called Medicare and they can't find it on the list of covered meds but she said she doesn't have the complete list so my doctor should call the medicare provider line etc. Can anyone help with the exact words to use with the pharmacy? Thanks (I have been on the phone trying to get the drug for weeks)
From what I currently understand, some large pharmacies -good luck finding them- who work with RMDs will deal with Medicare Part B. Many will not, and some of those will not even accept coupons. (My case) I’ve been told smaller pharmacies just don’t want the hassle. And, neither do I. I’m giving up and just going with a pharmacy that takes coupons.
I've decided to buy from the supplier direct since no one around here who will even take a coupon has the sodium chl 3% anyway. It's going to cost me $38 plus shipping but I'm worth that...plus the stress of the hunt and medicare issues isn't healthy for me anyway.
Can I ask, who that supplier is?
sent you a private message with info. Anyone else just ask and I will message you.
Hi @liz440. You said $38 plus shipping. What quantity does that buy? Is it enough for a month, twice a day? Thanks.
yes that is twice a day 60 little tubes of 4 ml per tube.
Thanks. That's less than I have to pay now. Will send a PM to you for supplier information.
@rmason, have you tried this coupon? It says you have to sign up and it's only good for a one time purchase. Sounds like more hassle than it's worth.