Connect
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!
Like
Helpful
HugInterested in more discussions like this? Go to the MAC & Bronchiectasis Support Group.
Connect
Here's the problem. If your Dr. ordered your nebulizer for you and you got it from some source other than Walgreens or some other nebulizer providing pharmacy, it is really next to impossible to get Medicare to pay. I have spent hours on the phone on this issue. My nebulizer came from some medical supply company and was free via Medicare. That supply company does not provide the solution so....you are left to find it at a pharmacy. Since the pharmacy did not provide the nebulizer they claim it isn't covered (one claimed it was covered if mixed with albuterol). That's my experience anyway. For $10.80 a month, it is not worth more of my time fighting this and Medicare doesn't provide a new nebulizer via anyone for 5 years or so unless maybe it breaks.
-
Like -
Helpful -
Hug
1 ReactionYes, through Walgreens and I have BCBS & Medicare. We have a phenomenal pharmacist at our local Walgreens, and he jumped through all the hoops to get it covered back in 2019. Even told me what the doctor's scrip needed to say. It probably helps that his store is the preferred supplier for several senior residences in our area, so he knows how to handle Medicare issues. When I had trouble getting it covered in Texas during the winter, he told the very inexperienced staff there what to do.
Sue
-
Like -
Helpful -
Hug
2 ReactionsLarry- This is such a frustrating mess. I, like others, have given up trying to get Medicare to pay for saline. I just refilled a 90 day supply of 7% saline at Walgreens in Asheville, NC, using a GoodRx coupon. Perhaps some areas of the country use different suppliers? Good luck. Donna T
-
Like -
Helpful -
Hug
1 ReactionWe were never successful in getting Medicare or insurance to pay for Nebulizers or 3% or 7.% saline solutions even with prescriptions. What alternative is there when it is prescribed and pharmacies refuse? Frustrating but not the end of the world for sure!
-
Like -
Helpful -
Hug
1 ReactionSue,
Can you ask your pharmacy what two code numbers they used?
Thanks,
Harry
I have asked - they will not tell me. But, the required codes a buried in the document I referred to above.
Sue
Sue,
Thanks. I read it over quickly and there are a lot of codes! Confusing also.
Guess I need to slow down and go over it again....
Harry
Just to add to your information, I recently read that CVS will no longer bill Medicare Part B for drugs. Donna T
That may be the case for CVS retail pharmacies, but CVS mail order still does so. I just checked on my Levalbuterol and budosenide neb solutions and they are covered. I also know that retail businesses that do not carry the nebulizer in store are not required by Medicare rules to do Part B Rx either.
Sue
I haven’t tried Mcare for any of this, but I have a thought. I suggest people call their senator or representative for assistance. I lived and worked in a state with a small population and there, senators and congressmen had a staff person to help with federal medical bureaucracy. It sounds like this issue probably affects a lot of people and I’d bet not only those with bronchiectasis. We are paying them to make the government work for us.
I can’t guarantee it’ll work, but people have little to lose-just a few minutes for a phone call. Ask for their medical person to call you back and ask them what the rules are, who should pay and coding info for doc and pharmacy.
-
Like -
Helpful -
Hug
1 Reaction