Does Medicare Part B cover sodium chloride solution?

Posted by lora jo @ljfoo, Mar 23, 2022

CVS says that neither Medicare Part D nor Medicare Part B covers the 3% or 7% sodium chloride I need. I've read on this discussion group that some of you have been able to get your sodium chloride covered by Medicare Part B. How did you do that? Is there a specific Diagnosis Code that your doctor has given your pharmacy? Can you ask your doctor what that code is? My pulmonologist is having a hard time figuring this out also.
lora jo

Interested in more discussions like this? Go to the MAC & Bronchiectasis Support Group.

Sue- thank you so much. It really helps to hear from others like you who have had success when knowing what to do. I really appreciate it. Donna

REPLY
@sayaboleh

Donna - I've been having great difficulty as well finding the 7% - did the same. Called around everywhere and no one had it. I was also told that they could not even order it from their wholesaler until late Feb and even then there was no definite delivery date. One particular Walgreens told me that they had not been been to get it for months. I persisted and miraculously they finally found some (in the back of a closet?) .
I live in Northern California but it sounds like this is happening elsewhere as well. It is quite exhausting trying to find this and also figuring out how to get Medicare to cover it.
I actually called Nephron, one of the generic manufacturers and they admitted to a shortage on their end a few months ago which has been resolved. so who knows what's causing the supply chain problem.
Mary

Jump to this post

Thanks, Mary. I wish you luck in your search. Please see Sue's reply- we will all need to be more insistent! Donna

REPLY
@donnaturn

Dear Martha,
I forgot to ask you if Publix will bill Medicare for you? My Publix pharmacy was successful with my Levalbuteral Rx, but not with saline. Thanks- Donna

Jump to this post

I looked back and my secondary payer (BC/BS fed. from my husband's employment/retirement) is covering it. I don't know if Medicare was ever billed or not, but it would probably have been a long time ago. This issue should definitely be fixed for a prescription medication that is so important to our community!!

REPLY

By the way, Publix told me they have the same unnamed distributor as Walgreens

REPLY
@ljfoo

Sue,
I don't believe sodium chloride is considered an inhaled medication. Is it? In the NTMir discussion group, someone said Medicare B covers her prescription for sodium chloride only if she picks it up along with her prescription for abuterol. If you asked only for the sodium chloride, she has to pay out of pocket. Are you saying you've been able to get CVS and Walgreens to cover just the sodium chloride? And do you know what Diagnosis Code your doctor has sent to CVS? Maybe my doctor is using the wrong code.
lora jo

Jump to this post

My husband asked CVS if it would be covered if he filled the prescription together with the one for albuterol and was told it wouldn't be covered.

REPLY
@gncellist

My husband asked CVS if it would be covered if he filled the prescription together with the one for albuterol and was told it wouldn't be covered.

Jump to this post

If CVS can get it you are lucky. My CVS, Walgreens etc can not even get the 3%. In any case you can use a goodrx coupon at CVS and that should make it lots less expensive. I have to pay $38 plus shipping to get mine from a supplier. No medicare no good rx! Nevertheless I am grateful I can get it at all since there is some kind of shortage in some parts of the country.

REPLY
@gncellist

My husband asked CVS if it would be covered if he filled the prescription together with the one for albuterol and was told it wouldn't be covered.

Jump to this post

Here is a long and ongoing discussion of the issue:
https://connect.mayoclinic.org/discussion/7-saline-prescription-and-medicare-part-b-payment-quandry/
The answer is "Yes!" However, in order for it to be covered the pharmacist must code it correctly. Here is the official document explaining what must be done:
https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=52466
I have since learned something interesting from CVS Mail Order - if a pharmacy sells nebulizers (even if they must order one for you) and takes Medicare, they are able to do this. Apparently most CVS stores choose not to do so. Many Walgreens do...

Where I live right now there are as many independent pharmacies as corporate ones - only those who handle durable medical equipment also handle saline and many other inhaled meds. It makes life crazy, I am fortunate that CVS Mail Order, part of my supplemental insurance coverage, also provides my saline & other inhalables.
Sue

REPLY
@sueinmn

Here is a long and ongoing discussion of the issue:
https://connect.mayoclinic.org/discussion/7-saline-prescription-and-medicare-part-b-payment-quandry/
The answer is "Yes!" However, in order for it to be covered the pharmacist must code it correctly. Here is the official document explaining what must be done:
https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=52466
I have since learned something interesting from CVS Mail Order - if a pharmacy sells nebulizers (even if they must order one for you) and takes Medicare, they are able to do this. Apparently most CVS stores choose not to do so. Many Walgreens do...

Where I live right now there are as many independent pharmacies as corporate ones - only those who handle durable medical equipment also handle saline and many other inhaled meds. It makes life crazy, I am fortunate that CVS Mail Order, part of my supplemental insurance coverage, also provides my saline & other inhalables.
Sue

Jump to this post

Thanks for the cvs mail info. I'm going to call them MOnday and see if they have 3% and if I am covered. That would certainly save me money. I randomly called a Walgreens in Texas and they had the 3% (would not mail) but not a single pharmacy (Walgreens, Walmart, Target, CVS) in my area within 50 miles has it.

REPLY

I just got off the phone CVS Caremark and they can mail the 3%- yippeee. Copay is 8.23 for a 90 day supply. I have no clue who they billed (I think Part B since they said Part D does not cover) They send a fax to your doctor to authorize the script and then the dr. faxes it back and then it takes 5-7 business days. They will charge your credit card. This just saved me $118.00. Thank you SUE

REPLY
@liz440

I just got off the phone CVS Caremark and they can mail the 3%- yippeee. Copay is 8.23 for a 90 day supply. I have no clue who they billed (I think Part B since they said Part D does not cover) They send a fax to your doctor to authorize the script and then the dr. faxes it back and then it takes 5-7 business days. They will charge your credit card. This just saved me $118.00. Thank you SUE

Jump to this post

The saga continues. Caremart/cvs called me back and said they can't submit to Part B because my Silver Script plan does not allow them to forward to part B for mail order drugs and they have to request prior authorization for Part D to pay for it (which they won't I can be sure). Also they have to have notification from the Dr that the local drugstore can not acquire it from their suppliers. This is madness. I am back to paying over $122 for 3 month supply I suppose. (2 hours on the phone so far)

REPLY
Please sign in or register to post a reply.