1. < MAC & Bronchiectasis

7% Saline Prescription and Medicare Part B payment quandry

Posted by Elle @ellen1944, Jan 28, 2023

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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crepass | @crepass | Jun 16, 2023
In reply to @mwturner "I live in Louisiana and have Humana Medicare Advantage. I pay $2,80 for a 30 day..." + (show)
@mwturner

I live in Louisiana and have Humana Medicare Advantage. I pay $2,80 for a 30 day supply.

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I too have humana advantage louisiana. Im getting my first mailing of 7% sod. Chloride. No charge. Not sure why.

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1 reply
healthybon | @healthybon | Jun 16, 2023
In reply to @larrydunn "I have struggled with MAC and bronchiectasis on and off for over 25 years, and have..." + (show)
@larrydunn

I have struggled with MAC and bronchiectasis on and off for over 25 years, and have gone through 2 extended cycles of the 3-drug protocol. Slightly different each time. I'm not sure I am completely MAC-bacteria free now, but I have been without the worst of the symptoms for a few years now. My pulmonologist has me on a twice per day nebulizer protocol of Albuterol and 7% saline. When this started several years ago, Medicare Part B (not Part D drug coverage) was covering the Albuterol and 7% saline with small copays. A couple of years ago they started refusing to cover the 7% saline, saying it was not a Medicare-approved treatment. My pulmonologist and several pharmacists have appealed to Medicare that this is a standard treatment for bronchiectasis, but were not able to convince them it should be covered. I have been getting one-month supply of the 7% saline (4 ml x 60 vials) at Walgreens for $10.28 using a GoodRX coupon. But just this week, Walgreens, and CVS, have told me the 7% saline 4 ml x 60 vials is "on backorder" and no availability date is given. I am at wits end about this. I just learned about availability via Amazon, though that is 50 packets for about $35, a huge increase. Any suggestions where to turn appreciated. (FYI: I am a 74 y.o. male). Thanks for listening.

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I belong to Amazon prime which means no shipping charge and I get it from them…

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1 reply
larrydunn | @larrydunn | Jun 16, 2023
In reply to @liz440 "It will cost about the same as Amazon at the link I sent you privately. I..." + (show)
@liz440

It will cost about the same as Amazon at the link I sent you privately. I think it is as I remember $32 plus shipping and you have to order 3 months worth to get the cheap shipping of $12...so the cost for 3% is about $36.00. (that is 60 vials) or #32. plus 12 if you only order 1 month. IT comes fast via fedex. Try a different Walgreens about 50 or so miles from your location. That's where I got it this month (about 35 miles away) and they are fedexing it for free. (3%). My local Walgreens is always "out of stock". My advice is first to call around at a distance first.

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Thanks so much. I will check this out. $10.28 per month using a GoodRx coupon at Walgreens didn't seem too terrible. But if they cannot get it in stock, I'm left high and dry (and congested).

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larrydunn | @larrydunn | Jun 16, 2023
In reply to @healthybon "I belong to Amazon prime which means no shipping charge and I get it from them…" + (show)
@healthybon

I belong to Amazon prime which means no shipping charge and I get it from them…

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Thanks. I just order some from Amazon yesterday. Cost 3 times more than what I've been paying at Walgreens. But my Walgreens can't seem to get it.

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larrydunn | @larrydunn | Jun 16, 2023
In reply to @crepass "I too have humana advantage louisiana. Im getting my first mailing of 7% sod. Chloride. No..." + (show)
@crepass

I too have humana advantage louisiana. Im getting my first mailing of 7% sod. Chloride. No charge. Not sure why.

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Thanks. I'll hope to find that good luck somewhere.

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larrydunn | @larrydunn | Jun 16, 2023
In reply to @roz14 "I used GoodRx at Walgreens one time and they keep it on file. I pay $10.00..." + (show)
@roz14

I used GoodRx at Walgreens one time and they keep it on file. I pay $10.00 for 60 4ml 7% Sodium Chloride. My Medicare did not want to pay for the 7%.

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Same for me . . . until my Walgreen's says they cannot get from their supplier.
🙁

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1 reply
liz440 | @liz440 | Jun 16, 2023
In reply to @larrydunn "Same for me . . . until my Walgreen's says they cannot get from their supplier...." + (show)
@larrydunn

Same for me . . . until my Walgreen's says they cannot get from their supplier.
🙁

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Do try other Walgreens. It really made a difference for me. My local Walgreens is a downer! However try near a major medical center area and then you may have more luck. Walgreens uses Fedex and ships free from the store if it is within so many miles (mine was around 40 miles away but same state). It's a war!

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Mentor
Sue, Volunteer Mentor | @sueinmn | Jun 16, 2023
In reply to @northland "We really need to petition our law makers for Medicare part B to pay for the..." + (show)
@northland

We really need to petition our law makers for Medicare part B to pay for the sodium chloride. If it doesn't have a drug included, they will not pay. However, Medicare is suppose to pay for all chronic lung medications, but they don't consider the sodium chloride as a medication. Can you get it without a prescription? If not, I consider it as a medication in my head. Confusing and plenty of expense annually.

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Here is the official Medicare Part B information on saline.
https://connect.mayoclinic.org/discussion/7-saline-prescription-and-medicare-part-b-payment-quandry/?pg=1#comment-803092
It's a tough slog to read your way through this, but worthwhile if you want the saline covered in the long term. I believe that the trick might be to get your doc to prescribe a nebulizer, to be secured through Medicare from your pharmacy (I KNOW Walgreens carries the one they cover.) That opens the Part B account, then the scrips are covered through Part B.

Different people make different decisions - some choose to go with GoodRx or pay out of pocket, others push through and get Medicare to cover it. Sometimes you need to change pharmacies - not all have Part B contract with Medicare.

Sue

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3 replies
dlynn1210 | @dlynn1210 | Jun 17, 2023

You only need a prescription if you want your insurance to pay for it. My daughter has been a 32 year RN and told me you don’t need a prescription for saline. She has a nebulizer and saline in case someone gets sick. They live on a remote mountain top in TN so not always possible to drive to a hospital or doctor’s office when one of them gets sick. My pulmonologist said he had no problem ordering the 7% for me but there has been a back order since the pandemic. That was weeks ago and so far I’ve heard nothing from our supplier.

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northland | @northland | Jun 17, 2023
In reply to @sueinmn "Here is the official Medicare Part B information on saline. https://connect.mayoclinic.org/discussion/7-saline-prescription-and-medicare-part-b-payment-quandry/?pg=1#comment-803092 It's a tough slog to..." + (show)
@sueinmn

Here is the official Medicare Part B information on saline.
https://connect.mayoclinic.org/discussion/7-saline-prescription-and-medicare-part-b-payment-quandry/?pg=1#comment-803092
It's a tough slog to read your way through this, but worthwhile if you want the saline covered in the long term. I believe that the trick might be to get your doc to prescribe a nebulizer, to be secured through Medicare from your pharmacy (I KNOW Walgreens carries the one they cover.) That opens the Part B account, then the scrips are covered through Part B.

Different people make different decisions - some choose to go with GoodRx or pay out of pocket, others push through and get Medicare to cover it. Sometimes you need to change pharmacies - not all have Part B contract with Medicare.

Sue

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are you saying Medicare is paying for your sodium chloride?

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